Advantra Plans - HMOs & PPOs
Advantra plans combine your Part A (hospital), Part B (medical) and Part D (prescription drug) coverage into one for one source of coverage.
In addition to medical and prescription drug coverage, Advantra offers many added benefits* like dental, vision, hearing, over-the-counter drug coverage and no-cost health club memberships.
Best of all, most of our plans offer coverage options for no or low monthly plan premiums.
How do Medicare Advantage coordinated care plans work?
A coordinated care plan (CCP) is much like the kind of health care you may already be familiar with through your or your spouse’s employer. There are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) and Point-of-Service (POS) plans.
Members in our HMO plans must use plan providers (sometimes called “in network” 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 our health plan will be responsible for the costs.
Members in our PPO or POS plans can go to doctors, specialists or hospitals in- or out-of-network. You may have to pay more for the services you receive outside the network and you may have to follow special rules.
Advantra is available to beneficiaries in select counties in several Coventry Health Care health plan service areas including: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Missouri, Nebraska, New Mexico, North Carolina, Ohio, Pennsylvania, South Dakota, Texas, Utah, Virginia, West Virginia and Wyoming.
*benefits may vary by plans and/or by county
Advantra (HMO/PPO/POS) is a Coordinated Care plan with a Medicare Advantage contract. This contract with the Centers for Medicare & Medicaid Services (CMS) is renewed annually; coverage beyond the end of the current contract year is not guaranteed. By law, Coventry can choose not to renew its contract with CMS and CMS may also refuse to renew the contract, thus resulting in a termination or non-renewal. This may result in termination of your enrollment in the plan. In addition, the plan sponsor may reduce its service area and no longer offer services in the area where the beneficiary resides.
Our Medicare Advantage plans are open to all Medicare beneficiaries eligible by age or disability and living in the plan’s service area. You must be entitled to Medicare benefits under Part A and be enrolled in Part B. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. If you switch to premium withhold or move from premium withhold to direct bill, it can take up to three months for the switch to take effect. You will be held responsible for those premiums. You may enroll during specific times of the year. You cannot enroll in this plan if your current or former employer helps pay for your drugs. For information on enrollment periods and for full information on Coventry benefits, please click here to contact our Customer Service Department.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2010. Please contact Coventry for details.
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/POS 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. 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 co-insurance 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.
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.
Medicare Prescription Drug Benefit is only available to members of the Medicare Advantage Prescription Drug (MAPD) plan; if a beneficiary is already enrolled in an MAPD plan, the enrollee must receive their Medicare Prescription Drug Benefit through that plan. Eligible beneficiaries must use network pharmacies to access their prescription drug benefits, except under non-routine circumstances when they cannot reasonably use network pharmacies.
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, seven days a week;
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday–Friday. TTY users should call 1-800-325-0778; or
- Your State Medicaid Office.
People with limited incomes may qualify for extra help to pay for their prescription drug costs. If eligible, Medicare could pay for 75% of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY/TDD users should call 1-877-486-2048.
The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan.
Medicare beneficiaries may also enroll through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov. You can also find plan rating information on this site. For more information, contact Coventry at 1-877-988-3589 (TTY/TDD: 1-888-788-4010 for the hearing impaired), 8 a.m. to 8 p.m., seven days a week.
Plan documents are available in other formats. For information about other formats, please click here to contact our Customer Service Department.
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