Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H4875-016-002

PriorityMedicare Merit (PPO) · Priority Health Medicare · Region 4

Compact plan code: H4875016002

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

PriorityMedicare Merit (PPO)

H4875-016-002 Region 4 Local PPO
Open in quick lookup
01

In-network

Inpatient hospital

Days 1–6 $275 / day
Days 7–90 $0 / day
Total of listed copays · 6 charged days $1,650
02

Emergency transport

Ambulance

Ground · in-network$270 copay
Air · in-network$270 copay
03

Emergency services

Emergency room

$130 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$4,200
Combined in + out$4,200
05

Skilled care at home

Home health

In-networkNo cost share reported
Out-of-networkNo cost share reported
06

Monthly cost

Premium & giveback

Part C premium$54.40 / month
Consolidated C + D$129 / month

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗

Same CMS contract

H4875-016-001 PriorityMedicare Merit (PPO) Region 3 · Local PPO H4875-016-003 PriorityMedicare Merit (PPO) Region 5 · Local PPO H4875-016-004 PriorityMedicare Merit (PPO) Region 1 · Local PPO H4875-016-005 PriorityMedicare Merit (PPO) Region 2 · Local PPO H4875-018-001 PriorityMedicare Thrive Plus (PPO) Region 1 · Local PPO H4875-018-002 PriorityMedicare Thrive Plus (PPO) Region 2 · Local PPO H4875-018-003 PriorityMedicare Thrive Plus (PPO) Region 3 · Local PPO H4875-018-004 PriorityMedicare Thrive Plus (PPO) Region 4 · Local PPO

About this code

What H4875-016-002 identifies

H4875-016-002 is a Contract Year 2026 Medicare plan segment code. The compact form H4875016002 refers to the same normalized contract, plan, and segment shown on this page.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.