Priority Health’s cost estimator and care management help members use a plan well, and employers should ask how often they are used.
Priority Health lists transparency tools and clinical support that members can use without an employer buy-up in most cases.
What the program is and what members do.
Cost Estimator
Priority Health says Cost Estimator, built with Healthcare Bluebook, takes provider and facility pricing information and combines it with member benefit and deductible balances to calculate anticipated out-of-pocket costs. It is listed for all commercial members, group and individual. Members need to log in and check it before scheduling care for it to change a decision.
PriceMyMeds
Priority Health says PriceMyMeds lets commercial members compare the cost of their medications across local, in-network pharmacies to find the lowest available price. It is a comparison tool, so the member still chooses where to fill the prescription. The savings depend on the plan’s pharmacy network and the drug involved, and Priority Health does not publish an average.
Care management and Ayble
Priority Health says its care management program pairs eligible members with licensed nurses or social workers who help manage conditions such as asthma, diabetes and depression, and help with new diagnoses and recent hospitalizations. Ayble provides GI-specialized nutrition guidance, coaching and care team support for digestive health.
Eligibility, funding and plan design.
Who qualifies
Cost Estimator and PriceMyMeds are listed for all commercial members. Care management is listed for any member with a chronic condition. Ayble is listed for adults on group commercial or MyPriorityHMO plans with digestive symptoms or diagnoses. Medicare and Medicaid members are on separate programs and are not the focus here.
How it is sold
Priority Health does not describe these as employer purchases in the pages we reviewed. They appear to be standard features, but the manual reminds readers that not all member plans may qualify where employers opted in or out. Confirm Ayble in particular.
Plan design fit
Transparency tools matter most for high-deductible plans, where members pay the first dollars. Care management matters for groups with a few high-cost chronic cases. Neither changes the rate, but both change how plan dollars are spent. Groups with high deductibles or concentrated chronic claims tend to see the most practical value from them.
What to settle before relying on it.
How many of our members use the Cost Estimator?
A tool nobody opens does nothing. Ask for group-level usage and for the typical savings Priority Health observes, and be cautious about averages from other groups. If use is low, communication, not the tool, is usually the fix. Low use is a communication problem you can fix with a short message at enrollment.
Who gets referred to care management, and how?
Ask how members are identified and contacted, whether employers can suggest referrals in aggregate terms, and how privacy is protected. Individual health information is protected, so the employer sees group-level reporting at most. Ask also whether outreach is by phone, mail or app, and whether members can decline without penalty.
Does Ayble apply to our group?
Priority Health lists Ayble for group commercial members with digestive conditions, but the manual’s opt-in note applies. Ask whether it is active for your group and whether any cost or enrollment step falls on employees. Confirm in writing before mentioning it in open enrollment materials, since the opt-in note may apply.
Common questions about this program.
Does Cost Estimator show exact prices?
Priority Health says it calculates anticipated out-of-pocket costs using provider and facility pricing and the member’s benefit and deductible balances. It is an estimate, and actual claims can differ.
Is care management an extra charge?
The Priority Health manual lists care management for any member with a chronic condition and does not describe a separate fee. Confirm for your group, since plan details vary.
Can an employer see which employees use these tools?
Not individually. Individual health information is protected, and employers should expect aggregate reporting at most. Confirm what Priority Health reports before launch.
Programs and vendors named on this page
Official pages for the services mentioned above. Availability, cost and eligibility vary by plan and employer group, so confirm what applies to your group with the carrier.
Healthcare Bluebook (now Vālenz Health)
Price and quality shopping for care.
Where these details come from.
This page summarizes what Priority Health publishes. Programs change, so confirm current details with the carrier before relying on them.
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The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
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