Eligibility Requirements

You are eligible to join Advantra (HMO/PPO) if:

• You are entitled to Medicare Parts A and B benefits due either to age or disability. With Advantra (HMO/PPO), you must continue to pay your Medicare Part B premium. If you do not have Medicare Part B, you are not eligible for Advantra (HMO/PPO) and must contact your nearest Social Security office and sign up for Part B.
• You live in the Advantra (HMO/PPO) service area.
• You have not been diagnosed with End-Stage Renal (kidney) Disease, unless you are already a member of Advantra (HMO/PPO) 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. You cannot enroll in this plan if your current or former employer helps pay for your drugs.

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 (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 will cost more to get care from out-of-network providers and /or that 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 the contracted amount is lower. Coventry provides reimbursement for all covered benefits regardless of whether they are received in-network, as long as they are medically necessary.

Some of our health plans offer Dual-eligible Special Needs Plans that are available to anyone in select service areas who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of help that you receive. Please contact the plan for details.

Some of our health plans offer Special Needs Plans that are available to all people with Medicare who have a diabetic condition or who have high cholesterol. If enrolling in one of these plans, you may be required to complete a Pre-Enrollment Qualification Assessment tool to verify that you have diabetes or high cholesterol. We may also verify your condition with your provider or your provider’s office. Please contact the plan for details.

If you have any questions regarding eligibility requirements, simply call us toll-free at 1-800-290-0190; Telephone number for hearing impaired only TDD: 1-800-207-1262, 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, seven 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.