When will my Coventry Medicare Advantage plan coverage become effective?

The effective date of enrollment in your plan will depend on (1) when Coventry receives your signed and completed enrollment form, and (2) the type of election period. We will send you a letter that tells you when your coverage begins. In general, once completed enrollment forms are received, the proposed effective date for coverage to begin will be on the first day of the following month.

There is one exception to this rule:

• Initial Election Period. When you first become entitled to both Part A and Part B of Medicare, your enrollment will be effective  the first day of the month you have coverage under both Medicare Part A and Part B.
• Annual Enrollment Period.  Elections made between October 15 and December 7 will become effective on January 1 of the following year.

Can I continue to go to my current doctors?

If you are a member of a Coventry Medicare Advantage Plan and your doctors are part of the Coventry network, you can continue to go to those providers. If not, you can choose one of hundreds of providers in our network to deliver your care. PPO members have the flexibility of managing their own care; however, if you do not see a network provider, you may be subject to higher cost sharing.

Please see your Evidence of Coverage document for additional information.

I already belong to another Medicare Advantage plan. Can I switch to a Coventry Medicare Advantage plan?

Yes. However, unless certain circumstances apply, you may change plans only during specific times of the year. As long as you are eligible, you may change to one of Coventry's Medicare Advantage plans and your other Medicare Advantage coverage will be canceled as soon as your Coventry Medicare Advantage coverage goes into effect.

What if I decide I no longer want my Medicare Advantage coverage from Coventry Health Care?

There are only certain times during the year when you may voluntarily end your membership in our Plan. The key time to make changes is the Medicare fall open enrollment period (also known as the “Annual Election Period”), which occurs every year from October 15 through December 7. This is the time to review your health care and drug coverage for the following year and make changes to your Medicare health or prescription drug coverage. Any changes you make during this time will be effective January 1.

Certain individuals, such as those with Medicaid, those who get extra help or who move, can make changes at other times.

You can also disenroll from our plan at any time of the year if you are eligible for the following Special Enrollment Periods during limited special exceptions, such as:

• You have a change in Residence
• You have Medicaid
• You are eligible for extra help with Medicare prescriptions
• You live in an institution (such as a nursing home)

Generally, your disenrollment will be effective first day of next month after plan receives your disenrollment request.

For more information about the options available to you during these enrollment periods, contact Medicare at 1-800-MEDICARE (1-800-633-4227.) TTY users should call 1-877-486-2048. Additional information can also be found in the “Medicare & You” handbook. This handbook is mailed to everyone with Medicare each fall. You may view or download a copy from www.medicare.gov - under “Search Tools,” select “Find a Medicare Publication.”

Will I need to keep my Medigap policy?

No. However, a Medigap policy could be of value to you if you leave a health plan and return to traditional Medicare. If you drop your Medigap policy, or never had a Medigap policy, you might not be able to buy the policy of your choice after you have been a member of a health plan for 12 months or more, especially if you have a health problem. Before giving up your Medigap policy, you should consider discussing your particular circumstance with your state’s Health Insurance Assistance Program (SHIP) office. A listing of offices is available by calling the 1-800-MEDICARE helpline available 24 hours or the www.medicare.gov website. The services are free.

Can I be involuntarily disenrolled from my Coventry Medicare Advantage plan?

Members can be involuntarily disenrolled for failure to pay premiums, a permanent move outside the plan’s geographic service area for six months or more, loss of Part B entitlement, fraud and/or disruptive behavior.

Can I change my Primary Care Physician once I’m enrolled?

Members in our HMO plans must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-plan providers, neither Medicare nor Coventry Health Care will be responsible for the costs. You can change primary care providers, but please contact us to verify that the provider you wish to see is part of our network.

Our PPO/POS plans allow you to see any provider within our network without referrals.  Please be sure the physician or facility you choose participates with your Medicare Advantage Plan from Coventry Health Care. If you select a provider that does not contract with Coventry, you may have to pay more. To verify his/her participation, either refer to your plan's Provider Directory or call the Member Service department toll-free at the number listed on your member ID card.

What isn’t covered by my Coventry Medicare Advantage plan?

A Medicare benefits specialist can answer specific questions for you. When you enroll, you will receive a complete list of benefits and exceptions in your plan materials, but these are the most common exclusions about which we are asked:

• Services and equipment which are not reasonable or medically necessary to treat an illness
• Plastic or cosmetic surgery unless medically necessary 
• Personal convenience items or services
• Meals delivered to the home
• Immunizations for travel or employment
• Experimental procedures or treatments in accordance with Medicare guidelines
• Special duty nurses unless medically necessary
• Private hospital room unless medically necessary and approved by your plan in advance
• Services covered by other insurance
• Custodial care
• Benefits and services not covered by Medicare unless specifically described as a covered service in your plan materials

Can my plan's benefit package change after I enroll?

Benefits under your Coventry Medicare Advantage plan are set for the calendar year (January 1 – December 31).  Our benefit package, premiums, copayments, formulary, and service area are all subject to change annually when the plan’s contract with the Center for Medicare and Medicaid Services (CMS) is reviewed.  The availability of coverage beyond the end of the current contract year is not guaranteed.

Formularies can change at any time during the year.  However, you will be notified at least 60 days prior to any formulary change before the change can take effect.  No formulary change can be made by the plan during the first 90 days of each contract year.