Eligibility Requirements

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Eligibility Requirements

You are eligible to join Coventry if:

  • You are entitled to Medicare Parts A and B benefits due either to age or disability. With Coventry, you must continue to pay your Medicare Part B premium. If you do not have Medicare Part B, you are not eligible for Coventry and must contact your nearest Social Security office and sign up for Part B.
  • You live in the service area.
  • You have not been diagnosed with End-Stage Renal (kidney) Disease, unless you are already a member of Coventry or had a successful kidney transplant.
  • You must be eligible for both Medicare and Medicaid to enroll in our Dual-eligible Special Needs Plans.

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 or other services. If you obtain non-emergent, routine care from out-of-network providers, neither Medicare nor Coventry will be responsible for the costs.

Members enrolled in plans that include a POS benefit can choose to go to providers 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 coinsurance 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.  Out-of-network options may vary by plan.  See your Summary of Benefits or Evidence of Coverage for more information.

Dual-eligible Special Needs Plans are available to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for details.

If you have any questions regarding eligibility requirements, simply call us toll-free at 1-877-866-3405 (TTY/TDD 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, 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.

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Page Last Updated: 01/02/2014
CMS Approved Date: Approved 02/08/2013
CMS Document ID: Y0022_PDPCCP_2013_4006_1202b

© Copyright 2008-2014 Coventry Health Care

Coventry Health Care is a Coordinated Care plan with a Medicare contract. First Health Part D is a Medicare-approved Part D sponsor. Enrollment in our plans depends on contract renewal.