How Do Medicare Advantage Plans Work?

A Medicare Advantage plan 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 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.

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 may cost more to get care from out-of-network providers. 

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

*benefits may vary by plans and/or by county

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Coventry Health Care is a Coordinated Care plan with a Medicare contract.

Coventry Health Care of Florida, Missouri, Kansas and Pennsylvania (HealthAmerica) also have contracts with the Florida, Missouri, Kansas and Missouri, and Pennsylvania state Medicaid programs (respectively). 

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, premium and/or co-payments/co-insurance may change on January 1 of each year.

Plan performance Star Ratings are assessed each year and may change from one year to the next.

Our dual-eligible Special Needs Plans (DSNPs) are available in Florida, Missouri, Kansas 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.

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 contact 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 through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.