Frequently Asked Questions
What else do you need to know? Here are a few questions people have asked prior to joining. If you don't see your question here, call us. We'll give you the information you need to help you decide whether a Coventry Medicare Advantage plan is right for you. Contact Us for more information.
Frequently Asked Questions
- When will my plan coverage become effective?
- Can I continue to go to my current doctors?
- I already belong to another Medicare Advantage plan. Can I switch to a Coventry Medicare Advantage plan?
- What if I decide I no longer want my coverage from Coventry?
- What if I move out of my plan’s service area?
- What if I receive a survey from Coventry about a move out of the service area and I haven’t moved?
- Will I need to keep my Medigap policy?
- Can I be involuntarily disenrolled from my plan?
- Can I change my Primary Care Physician once I’m enrolled?
- What isn’t covered by my plan?
- Can my plan's benefit package change after I enroll?
Frequently Asked Questions
When will my plan coverage become effective?
Generally, your coverage will begin on the first day of the month after your completed enrollment form is received.
Can I continue to go to my current doctors?
Generally, you must receive care from a network provider.
I already belong to another Medicare Advantage plan. Can I switch to a Coventry Medicare Advantage plan?
Most people can only enroll in a new plan during certain times of the year.
- Between October 15 – December 7 anyone can join, switch, or drop a Medicare plan.
- In certain situations, you may be able to join, switch, or drop a Medicare plan during a Special Enrollment Period. Examples include:
- If you move out of your plan’s service area.
- If you have Medicaid.
- If you qualify for Extra Help.
- If you live in an institution (like a nursing home).
What if I decide I no longer want my coverage from Coventry?
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.
Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you’ll have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage.
Certain individuals, such as those with Medicaid, those who get extra help, or those who move in/out of a plan’s service area, can make changes at other times.
You can also disenroll from our plan if you are eligible for a Special Enrollment Period. Examples that qualify you for a special enrollment include:
- You move in or out of a plan’s service area
- You have Medicaid
- You are eligible for extra help with Medicare prescriptions
- You live in an institution (such as a nursing home)
You may use any of the following ways to disenroll from our Medicare Advantage plans:
- Write a letter or fill out a disenrollment form.
- Please fax the form to 1-888-554-7668 OR
- Mail it to our Enrollment Department at: PO Box 7770, London KY 40742-9831.
- Note, all disenrollment requests must be signed by the member or the member’s legal representative for them to be processed.
- Call Member Services – please use the number on the back of your member ID card.
- Call 1-800-MEDICARE (1-800-633-4227) (TTY/TDD users should call 1-877-486-2048) 24 hours a day 7 days, seven days a week.
- Completed disenrollment forms must be received and processed by the end of the month for the disenrollment to be effective for the 1st of the following month. If you are requesting a disenrollment after the 15th of the month, it is suggested that the form be faxed in order to ensure that it is received and processed before the end of the month. Our fax number is 1-888-554-7668.
- If you want to be disenrolled, please file your disenrollment in one of the defined manners above, please do not quit paying your plan premiums and assume that you will be disenrolled.
- You will receive a letter from your plan confirming that your disenrollment/cancellation request has been approved, denied or if additional information is needed.
- If you would like to cancel your recent enrollment and it’s prior to your effective date with your plan, you do not need to fill out a disenrollment form, you can verbally request a cancellation of your enrollment by calling your plan.
What if I move out of my plan’s service area?
You must live in our service area to remain a member of our plan. Please notify us immediately if you move. If you move outside of a plan’s service area you will be disenrolled for the 1st of the following month.
To continue coverage with Coventry, you need to enroll in a plan that offers coverage in your new service area. You need to complete a new enrollment application for this enrollment to take place – we are unable to automatically transfer you from one plan to another.
Things to expect if you decide to continue coverage with Coventry:
- You need to complete an enrollment application for a plan in your new service area. Please call us for assistance in completing an enrollment application. The call will take approximately 10-15 minutes.
- It is helpful to have your red, white, and blue Medicare card available when placing this call.
- Please advise that you are requesting enrollment in a new plan because you have moved in or out of a service area.
- You will receive a confirmation of disenrollment letter from the plan in your previous service area AND a confirmation of enrollment letter from the plan in your new service area. This information is to confirm that you were appropriately disenrolled from your old plan and now enrolled in your new plan.
What if I receive a survey from Coventry about a move out of the service area and I haven’t moved?
In an effort to ensure that our records are as accurate as possible, please complete and return the form. Completing this form will help ensure there is no interruption to your coverage. You may also respond to our request for information by calling us.
Will I need to keep my Medigap policy?
You can’t use (and can’t be sold) a Medicare Supplement Insurance (Medigap) policy while you’re in a Medicare Advantage Plan. If you already have a Medigap policy and join a Medicare Advantage Plan, you’ll probably want to drop your Medigap policy. If you drop your Medigap policy, you may not be able to get it back. 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 1-800-MEDICARE (TTY/TDD users should call 1-877-486-2048) available 24 hours a day, 7 days a week or by visiting the www.medicare.gov website. The services are free.
Can I be involuntarily disenrolled from my plan?
Yes. There are instances in which we are required to end your membership in our plan. Examples include: failure to pay premiums; if you are away from our service area for more than 6 months, loss of continuous Medicare Part A and Part B coverage, if you become incarcerated, fraud and/or disruptive behavior.
Can I change my Primary Care Physician once I’m enrolled?
Yes, you can change your primary care provider. Please refer to our Provider Directory for assistance in locating a primary care provider.
What isn’t covered by my plan?
Each plan is different so it’s important you refer to the plan’s Evidence of Coverage (EOC). The EOC serves as the legal contract between the member and the plan and will provide specific information on benefits and coverage. While not a complete list, below 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
- Special duty nurses, unless medically necessary
- Private hospital room, unless medically necessary and approved by your plan in advance
- 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 plan are set for the calendar year (January 1 – December 31). Our benefits, formulary, pharmacy network, premium and/or co-payments may change on January 1 of each year.
Medicare allows plans to make some changes to their formulary throughout the year. If we remove a drug from our formulary or a negative maintenance change is made, we will notify affected members of the change at least 60 days before the change becomes effective. If the Food and Drug Administration (FDA) determines a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary for your safety and provide notice to members who take the drug shortly after the removal.
Online Request Forms
Member Request for Coverage Determination
Member Request for Redetermination (Appeal)
Medicare Complaint Form
Member Forms & Resources
Formulary (Drug List)
Medication Therapy Management Program
Transition Policies and Exceptions Process
Prescription Drug Forms