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.

HMO/PPO/POS Plans from Coventry Health Care

HMO/PPO/POS plans from Coventry Health Care combine your Part A (hospital), Part B (medical) and Part D (prescription drug) coverage into one source of coverage.

In addition to medical and prescription drug coverage, these plans offer 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.

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 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 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.

HMO/PPO/POS plans from Coventry Health Care are available to beneficiaries in select counties in several service areas including:  Florida, Georgia, Illinois, Iowa, Kansas, Missouri, Nebraska, North Carolina, Ohio, Pennsylvania, South Dakota, Texas, Utah, and Wyoming.

*benefits may vary by plans and/or by county

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Our Medicare Advantage plans are a product of Coventry Health and Life Insurance Company and its subsidiary companies, a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), or Point of Service (POS) plan with a Medicare contract with the Centers for Medicare & Medicaid Services renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed. Our Medicare Advantage plans are open to all Medicare beneficiaries eligible by age or disability in the plan's service area. You must be entitled to Medicare benefits under Part A and enrolled in Part B, and reside in the plan’s service area. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third-party. You may enroll during specific times of the year. For details on any information listed above, click here to contact customer service. You cannot enroll in this plan if your current or former employer helps pay for your drugs.

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/TDD users should call 1-877-486-2048, 24 hours a day/7days a week; The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or your State Medicaid office.

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.

AdvantraExtra Chronic Care Special Needs Plans are available in select service areas to all people with Medicare who have a diabetic condition or who have high cholesterol. You may be required to complete a Pre-enrollment Qualification Assessment tool to verify that you have diabetes and or high cholesterol and/or we may verify your condition with your provider or your provider’s office.

AdvantraOne Dual Eligible Special Need Plans are available in select service areas to anyone who has both Medical Assistance from the state and Medicare.

HMO members must receive all routine care from plan providers, except in emergent 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 and Life Insurance Company will be responsible for the costs.

POS and PPO members 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 must follow special rules in order for Coventry Health and Life Insurance Company to pay for these services. Otherwise neither Coventry Health and Life Insurance Company nor Original Medicare will pay for these services. Member responsibility may be greater out-of-network since coinsurance is based on the Medicare-allowed amount and not on the potentially lower contracted amount.

For full information on Advantra benefits, please click here to contact customer service. 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, 7 days a week. The TTY number is 1-877-486-2048.

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