Michigan health plan · 2026

MyPriority Balanced Silver · 29698MI0541220

Priority Health offers this marketplace health insurance plan (Plan ID 29698MI0541220) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: HMO CSR: 87% AV Level Silver Plan Issuer: Priority Health
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 87.40%. Expect to pay roughly 12.60% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 88.41% (11.59% member share on average). Learn about AV methodology.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$364 – $1793

Before subsidies

Estimate after subsidies

Deductible

$1,200

$2400 per group

See deductible details

Max out-of-pocket

$2,400

$4800 per group

Review MOOP rules

Office visits

Primary care $10.00
Specialist $40.00
HSA Not eligible

Drug tiers

Generic $5.00
Preferred brand $70.00 Copay after deductible

View formulary tiers

$555 / mo before subsidies

≈ $6660 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1757 / mo before subsidies

≈ $21089 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2077 / mo before subsidies

≈ $24929 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1336 / mo before subsidies

≈ $16027 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

20.00% Coinsurance after deductible

Durable Medical Equipment

50.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Michigan). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • 87% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

20.00% Coinsurance after deductible

Durable Medical Equipment

50.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 29698MI0541220
Coverage year 2026
State Michigan
Issuer Priority Health
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 29698MI0541220-05
Available variants

Standard Off Exchange Plan · 29698MI0541220-00

Standard On Exchange Plan · 29698MI0541220-01

Open to Indians below 300% FPL · 29698MI0541220-02

Open to Indians above 300% FPL · 29698MI0541220-03

73% AV Silver Plan · 29698MI0541220-04

87% AV Silver Plan · 29698MI0541220-05

94% AV Silver Plan · 29698MI0541220-06
Last plan update Wed, 15 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Michigan 25874
PCPs in Michigan 5327
Telehealth support Data pending
Nationwide providers 51508
25,874 doctors statewide 5,327 PCPs 130 OB/GYN

Provider network(s)

Providers Michigan All US states
All 25874 51508
PCP 5327 5796
Allergy 16 17
OB/GYN 130 151
Dentists 30 32

Drug coverage overview

5,490 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
FORMULARY-BRANDS 4,315
FORMULARY-SPECIALTY 678
NON-FORMULARY-SPECIALTY 497
Prior authorization Drugs
Required 817
Not Required 4,673
Step therapy Drugs
Required 498
Not Required 4,992
Quantity limits Drugs
Has Limit 2,121
No Limit 3,369

Customer highlights

What stands out for members

  • Issuer: Priority Health · Plan ID 29698MI0541220 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 29698MI0541220-05 (87% AV Silver Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Maximum 30 visits per member per year.

Diabetes Education

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Home Health Care Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Including hospice care in the home.

Laboratory Outpatient and Professional Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Primary Care Visit to Treat an Injury or Illness

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

This plan includes one annual physical/wellness exam at no cost to the member.

Rehabilitative Occupational and Rehabilitative Physical Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Combined maximum of 30 visits per year.

Rehabilitative Speech Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Maximum of 30 visits per year.

Specialist Visit

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Urgent Care Centers or Facilities

$75.00
Tier 1 in-network $75.00
Out-of-network 100.00%

X-rays and Diagnostic Imaging

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Dialysis

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Durable Medical Equipment

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Emergency Room Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Emergency Transportation/Ambulance

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Hospice Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Inpatient Hospital Services (e.g., Hospital Stay)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Inpatient Physician and Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Outpatient Services

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$1000.00 Copay after deductible, 20.00% Coinsurance after deductible
Tier 1 in-network $1000.00 Copay after deductible, 20.00% Coinsurance after deductible
Out-of-network 100.00%

Outpatient Rehabilitation Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 90.0 Visit(s) per Year

Up to 90 visits per year: limited to 30 speech therapy visits, 30 occupational and physical therapy, and 30 cardiac and pulmonary rehabilitation visits per member per year. See SBC for details.

Outpatient Surgery Physician/Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Radiation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Skilled Nursing Facility

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 45.0 Days per Year

Up to 45 days per benefit period. This limit is combined with subacute facility and inpatient rehabilitation care facility services.

Substance Abuse Disorder Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Substance Abuse Disorder Outpatient Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Transplant

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Mental health & substance use

Behavioral health visits and substance use treatment.

Autism Spectrum Disorders

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Only covered in relation to Autism Spectrum Disorder.

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Routine care is covered as preventive. Complications of Pregnancy is diagnostic/medical care will be covered as indicated by the SBC document.

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

One exam per year. See SBC for details.

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

Refer to the drug list for quantity limits and other exclusions.

Non-Preferred Brand Drugs

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Refer to the drug list for quantity limits and other exclusions.

Preferred Brand Drugs

$70.00 Copay after deductible
Tier 1 in-network $70.00 Copay after deductible
Out-of-network 100.00%

Refer to the drug list for quantity limits and other exclusions.

Specialty Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Refer to the drug list for quantity limits and other exclusions. In accordance with state law, the maximum copayment per 30-day fill for orally administered chemotherapy drugs are capped at $250 or less. Deductible may apply.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Dietician Services.

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Applied Behavior Analysis Based Therapies

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Only covered in relation to Autism Spectrum Disorder.

Bariatric Surgery

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Procedure(s) per Lifetime

One procedure per lifetime.

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

One select eyeglass frame and one set of lenses, or provider designated contact lenses in lieu of eyeglass frames and lenses, per year.

Habilitation Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

Up to 60 visits per year: limited to 30 speech therapy visits and 30 occupational and physical therapy rehabilitation visits per member per year (non-Autism Spectrum Disorder). See SBC for details.

Imaging (CT/PET Scans, MRIs)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Infertility Treatment

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limits and exclusions apply. Diagnosis and treatment of underlying cause only. See SBC document.

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Specified Sex-Trait Modification Procedures

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Treatment for Temporomandibular Joint Disorders

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Coverage includes medical care or services to treat dysfunction or TMJS resulting from a medical cause or Injury, Office visits for medical evaluation and treatment, X-rays of the temporomandibular joint including contrast studies, but not dental x-rays, Myofunctional therapy and Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis.

Variant attributes

MyPriority Balanced Silver · Variant 29698MI0541220-05

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

87% AV Level Silver Plan

HIOS Product ID

29698MI054

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

29698MI0541220-05

Plan Marketing Name

MyPriority Balanced Silver

Plan Variant Marketing Name

MyPriority Balanced Silver

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

87.40%

Issuer ID

29698

Issuer Marketplace Marketing Name

Priority Health

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

MIN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency Care Only

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Urgent/Emergency Care Only

Service Area ID

MIS001

State Code

MI

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.884149472

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$1,200

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$1,200

SBC Scenario, Having Diabetes, Coinsurance

$300

SBC Scenario, Having Diabetes, Copayment

$900

SBC Scenario, Having Diabetes, Deductible

$1,200

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$300

SBC Scenario, Treatment of a Simple Fracture, Copayment

$100

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,200

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

20.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$4800 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$2400 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$2,400

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

MIF004

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

EHB Percent of Total Premium

1

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

New

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

HMO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

29698MI0541220

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$2400 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$1200 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$1,200

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Michigan?

MyPriority Balanced Silver (29698MI0541220) is a Silver HMO from Priority Health in Michigan for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does MyPriority Balanced Silver support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is MyPriority Balanced Silver HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does MyPriority Balanced Silver support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with MyPriority Balanced Silver?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for MyPriority Balanced Silver?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency Care Only

Does MyPriority Balanced Silver cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Urgent/Emergency Care Only

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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