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

2026 Medicare plan code

H4875-804-000

PriorityMedicare PPO EG Calendar Year (PPO) · Priority Health Medicare · National

Compact plan code: H4875804000

2026

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

● CMS 2026 plan record

PriorityMedicare PPO EG Calendar Year (PPO)

H4875-804-000 National Local PPO Employer-only
Open in quick lookup
01

In-network

Inpatient hospital

Per admission $0 per stay
Plan-listed inpatient copay $0
02

Emergency transport

Ambulance

Ground · in-network20% coinsurance
Air · in-network20% coinsurance
03

Emergency services

Emergency room

20% coinsurance

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$6,800
Combined in + out$10,000
05

Skilled care at home

Home health

In-networkNo cost share reported
Out-of-network20% coinsurance
06

Monthly cost

Premium & giveback

Part C premiumNot reported
Consolidated C + DNot reported

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 H4875-016-002 PriorityMedicare Merit (PPO) Region 4 · 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

About this code

What H4875-804-000 identifies

H4875-804-000 is a Contract Year 2026 Medicare plan segment code. The compact form H4875804000 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.