Eligiblity Requirements
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- Advantra (HMO/PPO) - IA, NE, SD
- Eligiblity Requirements
You are eligible to join Advantra if:
- You are entitled to Medicare Parts A and B benefits due either to age or disability. With Advantra, you must continue to pay your Medicare Part B premium. If you do not have Medicare Part B, you are not eligible for Advantra and must contact your nearest Social Security office and sign up for Part B.
- You live in the Advantra service area.
- You have not been diagnosed with End-Stage Renal (kidney) Disease, unless you are already a member of Advantra or had a successful kidney transplant.
Medicare Prescription Drug benefits are only available to beneficiaries with Part D Prescription Drug coverage or members of a Medicare Advantage Prescription Drug plan.
Members in our HMO plans must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers, neither Medicare nor Coventry Health Care (and all subsidiaries) will be responsible for the costs.
Members in our PPO plans can go to doctors, specialists or hospitals in- or out-of-network. With the exception of emergency or urgent care, it may cost more to get care from out-of-network providers. Accessing services from in-network providers can cost less than using services of out-of-network providers. Your responsibility will be greater out-of-network when the out-of-network co-insurance is based on the Medicare allowed amount and coinsurance in-network is based on the contracted amount which is probably lower. Coventry provides reimbursement for all covered benefits regardless of whether they are received in-network, as long as they are medically necessary.
If you have any questions regarding Advantra's eligibility requirements, simply call an Advantra sales representative toll-free at 1-877-886-7564 (TDD/TTY: 711 Telecommunications Relay Service), 8 a.m. to 8 p.m., local time, seven days a week.
You can also call 1-800-Medicare (1-800-633-4227) to ask questions or get free information booklets from Medicare. You can call this national Medicare helpline 24 hours a day, 7 days a week. The TTY/TDD number is 1-877-486-2048. Domain names, trademarks and copyrights of other websites or of, or contained in, information on this website are the sole property of their respective owners.
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