Medicare Advantage Plans
What is a Medicare Advantage (MA) Plan?
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.
Medicare Advantage plans combine your Part A (hospital) and Part B (medical) into one source of coverage. Most Coventry Health Care plans also include Part D (prescription drug) coverage. In addition to medical and prescription drug coverage, our plans offer many added benefits* like dental, vision, hearing, over-the-counter drug coverage and no-cost health club memberships.
Coverage Rules in Medicare Advantage Plans
Medicare Advantage Plans must cover all of the services that Original Medicare covers. When you are in an MA plan, you still have Medicare. There are several types of MA plans including:
- Health Maintenance Organization (HMO) Plans - Provides coverage for plan members through a network of locally contracted providers. 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 or other services. If you obtain routine care from out-of-network providers, neither Medicare nor Coventry Health Care (and all subsidiaries) will be responsible for the costs.
- Preferred Provider Organization (PPO) Plans - Provides coverage for plan members through a network of locally contracted providers. Members in our PPO plans can go to any doctor, specialist or hospital whether they are 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.
- HMO Point-of-Service (HMOPOS) Plans - Provides coverage for plan members through a network of locally contracted doctors and hospitals. Members in our POS plans may use a provider who is not in our network for some services. With the exception of emergency or urgent care, it may cost more to get care from out-of-network providers. While the POS option provides more choice and flexibility, it is important to remember that not all services are available outside the network of contracted providers.
- Most of our MA plans also include Part D Prescription Drug Coverage. Here, we contract with pharmacies nationally that you can use to get your drugs. Our members can fill their prescriptions at an out-of-network pharmacy if the prescriptions are related to care for a medical emergency or urgently needed care.
- For detailed coverage information for any of our plans, please refer to the plan’s Evidence of Coverage.
*benefits may vary by plans and/or by county.
Coventry Health Care* is a Coordinated Care plan with a Medicare contract. Enrollment in our plans depends on contract renewal.
Coventry Health Care of Florida also has a contract with the Florida state Medicaid program. Coventry Health Care of Missouri and Coventry Health Care Kansas also have contracts with the Missouri state Medicaid program. HealthAmerica also has a contract with the Pennsylvania state Medicaid program.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
Limitations, copayments, and restrictions may apply.
Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
Our dual-eligible Special Needs Plans (DSNPs) are available in Florida, Missouri and Pennsylvania 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 further details. Our dual-eligible Special Needs Plans (DSNPs) are available to anyone who has both Medical Assistance from the State and Medicare.
You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual members where DSNP plans are available.
This information is available for free in other languages. Please call Coventry Health Care at 1-877-988-3589, 8 a.m. to 8 p.m., seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30.
Medicare beneficiaries may also enroll in Coventry plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
*Coventry Medicare Advantage plans are offered by Coventry Health Care, Inc.’s licensed affiliated companies, which include Altius Health Plans, Inc.; Coventry Health Care of Florida, Inc.; Coventry Health Plan of Florida, Inc.; Coventry Health Care of Georgia, Inc.; Coventry Health Care of Illinois Inc.; Coventry Health Care of Iowa, Inc.; Coventry Health Care of Louisiana, Inc.; Coventry Health Care of Missouri, Inc.; Coventry Health Care of Nebraska, Inc.; Coventry Health and Life Insurance Company; Coventry Health Care of Kansas, Inc.; Coventry Health Care of Texas, Inc.; Coventry Health Care of West Virginia, Inc. ;Coventry Summit Health Plan, Inc.; First Health Life & Health Insurance Company; HealthAmerica Pennsylvania, Inc.; and HealthAssurance Pennsylvania, Inc.
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