Notices & Disclaimers
Notices and Disclaimers
Advantra Freedom (PFFS)
A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital can continue to treat you if it agrees to accept our terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can click on the following link to find the plan’s terms and conditions on this website.
Advantra Freedom (PFFS) is a Medicare approved Medicare Advantage Private Fee-for-Service plan offered through the following Coventry Health Care, Inc. subsidiaries: First Health Life & Health Insurance Company, Coventry Health and Life Insurance Company and Cambridge Health Insurance Company.
The Advantra Freedom (PFFS) contract with CMS is renewed annually and the availability of coverage beyond the contract year is not guaranteed.
You may only enroll in Advantra Freedom (PFFS) during specific time of the year. For more information contact Advantra Freedom at 1-800-711-1607 (TDD/TTY: 1-888-788-4010), 8 a.m. to 8 p.m., seven days a week.
You are eligible to join Advantra Freedom (PFFS) if:
1) You are entitled to Medicare Part A and are enrolled in Medicare Part B. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.
2) You reside within the plan's service area.
3) You have not been diagnosed with end-stage renal (kidney) disease, unless you are already a member of Advantra Freedom (PFFS) or had a successful kidney transplant.
4) You are not 65 but are disabled and have recently received disability benefits from Social Security or the Railroad Retirement Board for at least 24 months.
Advantra Freedom (PFFS) Part D benefits are only available to members of our Freedom 4, Freedom 5, Freedom 5 Plus – OTC, Freedom 5 Plus – Gap and Freedom 7 plans. If you are enrolled in Freedom 4, Freedom 5, Freedom 5 Plus – OTC, Freedom 5 Plus – Gap or Freedom 7, you must receive your Medicare Part D coverage through Advantra Freedom (PFFS). Enrollment in another Medicare Part D plan will cause you to be automatically disenrolled from Advantra Freedom (PFFS). Enrollment in an Advantra Freedom (PFFS) MAPD plan which includes Part D prescription drug coverage will automatically end your enrollment in a Medicare prescription drug plan.
You must use network pharmacies to access your drug benefits, except under non-routine circumstances when you cannot reasonable use a pharmacy in the network. For additional network pharmacy information visit our online pharmacy locator or contact 1-800-690-5924 or 1-800-690-4028 for NY residents (TTY/TDD 1-800-716-3231), 24 hours a day, seven days a week or write to us at Advantra Freedom: Coventry Health Care, Inc. PO Box 7154, London, KY 40742-7154.
If you enroll in an MA only plan that does not offer Medicare prescription drug coverage, you may obtain coverage from a separate Medicare prescription drug plan. If you do not have Medicare prescription drug coverage, or creditable prescription drug coverage (as good as Medicare’s), you may have to pay a late enrollment penalty if you enroll in Medicare prescription drug coverage in the future.
If you decide to switch to premium withhold or move from premium withhold to direct billing, it could take up to three months for it to take effect and you will ultimately be held responsible for those premiums. For full information on Advantra Freedom (PFFS) benefits, call our Customer Service Department at 1-800-711-1607 (TDD/TTY: 1-888-788-4010), 8 a.m. to 8 p.m., seven days a week.
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 seventy five (75) percent 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 users should call 1-877-486-2048. If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare may pay all or some portion of your plan premium. If Medicare pays only a portion of this premium, you will receive a coupon book to pay your remaining premium that Medicare does not cover.
If a person is discussing plan options with you, he or she may be either employed by or contracted with First Health Life & Health Insurance Company, Coventry Health and Life Insurance Company, and/or Cambridge Life Insurance Company, subsidiaries of Coventry Health Care, Inc. This person may be compensated based on your enrollment in the Advantra Freedom (PFFS) plan.
Medicare beneficiaries may also enroll in Advantra Freedom (PFFS) through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov. For more information, contact Advantra Freedom at 1-800-711-1607 (TDD/TTY: 1-888-788-4010), 8 a.m. to 8 p.m., seven days a week.
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.
Plan documents are available in other formats. For more information contact Advantra Freedom (PFFS) at 1-800-711-1607 (TDD/TTY: 1-888-788-4010), 8 a.m. to 8 p.m., seven days a week.
AdvantraRx (PDP)
AdvantraRx (PDP) is a Medicare-approved Part D sponsor. The contracts with the Centers for Medicare & Medicaid Services (CMS) are renewed annually; coverage beyond the end of the current contract is not guaranteed. Our plan is authorized by law to refuse to renew its contract with CMS and CMS also may refuse to renew the contract. Termination or non-renewal may result in termination of your enrollment in our plan. AdvantraRx (PDP) may reduce its service area and no longer offer services in the area where you reside.
You must be entitled to Medicare benefits under Part A and/or enrolled in Part B, and reside in the AdvantraRx (PDP) service area. You may only enroll in one Part D Benefit Plan (PDP) at a time and only during specific times of the year. If you are enrolled in a Medicare coordinated care (HMO or PPO) plan or a Medicare Advantage (MA) Private Fee-for-Service (PFFS) plan that includes Medicare prescription drugs, you may not enroll in a PDP unless you disenroll from the HMO, PPO or MA PFFS plan. Enrollees in a PFFS plan that does not provide Medicare prescription drug coverage, or a MA Medical Savings Account (MSA) plan may enroll in a PDP. Enrollees in an 1876 Cost plan may enroll in a PDP. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third-party.
Medicare beneficiaries may enroll in AdvantraRx (PDP) through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov. For more information contact AdvantraRx (PDP) at 1-800-882-3822 (TTY/TDD users call 1-888-788-4010), 8 a.m. to 8 p.m., seven days a week. Brokers are paid a commission upon beneficiary enrollment.
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 seventy five (75) percent 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 users should call 1-877-486-2048.
If you decide to switch to premium withhold or move from premium withhold to direct billing, it could take up to three months for it to take effect and you will ultimately be held responsible for those premiums.
Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances when they cannot reasonably use network pharmacies. In general, benefits are only available at contracted network pharmacies.
Benefits, formulary, pharmacy, network premium and/or co-payments/co-insurance may change on January 1, 2010. Please contact AdvantraRx (PDP) for details.
Documents are available in alternative formats or languages. Call AdvantraRx (PDP) at 1-800-882-3822 (TTY/TDD users call 1-888-788-4010), 8 a.m. to 8 p.m., seven days a week for information about other formats or languages.
Advantra Savings (MSA)
Advantra Savings (MSA) is a Medicare-approved Medicare Advantage Medical Savings Account plan offered through First Health Life & Health Insurance Company, a subsidiary of Coventry Health Care, Inc., which contracts with the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare. The Advantra Savings (MSA) contract is renewed annually and the availability of coverage beyond the end of the current year is not guaranteed.
Advantra Savings (MSA) is not a Medicare supplement, Medigap, Medicare Select or Prescription Drug Plan. It is a Medicare Advantage plan and you still have Medicare; however your claims will be processed through Coventry Health Care for your Advantra Savings (MSA) plan. MSA Plans combine a high deductible Medicare Advantage Plan and a bank account. The plan deposits money from Medicare into the account. You can use the money in this account to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally will have to pay out-of-pocket before your coverage begins. Unlike an HMO, there is no predetermined provider network with this type of plan, so your providers are entitled to the same reimbursement they would receive under traditional Medicare.
You can generally join an Advantra Savings (MSA) plan if you meet these conditions:
- You have Part A and Part B and continue to pay your Medicare Part B premium (if not otherwise paid for by another third party)
- You live in the plan's service area
- You don't have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) except under certain circumstances
You are not eligible to enroll in Advantra Savings (MSA) if:
- You have an employer, union group health plan or other insurance that covers all or part of the Medicare MSA plan deductible
- You are eligible for benefits through the Department of Defense (TRICARE) or the Department of Veteran Affairs (VA)
- You are a retired Federal employee and part of the Federal Employee Health Benefits Program (FEHBP)
- You are eligible for Medicaid
- You are currently getting hospice care
- You live outside the United States more than 183 (total) days a year
You may only enroll in Advantra Savings (MSA) during specific times of the year. Enrollment in Advantra Savings (MSA) will automatically end your enrollment in another Medicare health plan. Enrollment is generally for the full calendar year. You can disenroll from Advantra Savings (MSA) between November 15 and December 31 of each year. Your disenrollment will be effective January 1 of the next year. You can’t disenroll between January 1 to March 31. You may not disenroll or make changes at other times unless you meet certain special exceptions, such as if you move out of the plan’s service area, qualify for Medicaid, or qualify for Extra Help with Medicare prescription drug costs. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. For more information contact Advantra Savings at 1-800-474-5993 (TDD/TTY: 1-888-788-4010), 8 a.m. to 8 p.m., seven days a week.
Medicare MSA Plans don’t cover prescription drugs. If you join a Medicare MSA Plan, you can also join a Medicare Prescription Drug Plan to get drug coverage. If you do not have Medicare prescription drug coverage, or creditable prescription drug coverage (as good as Medicare's), you may have to pay a late enrollment penalty if you enroll in Medicare prescription drug coverage in the future.
Unless you select an alternative MSA trustee, we will automatically open an MSA account for you with HealthEquity, Inc. when you enroll in Advantra Savings (MSA). HealthEquity, Inc., is an independent financial institution that Coventry Health Care, Inc., has contracted with to administer the savings accounts for Advantra Savings (MSA). HealthEquity, Inc., is not an affiliate of Coventry Health Care, Inc.
You must file Form 1040, US Individual Income Tax Return, along with Form 8853, “Archer MSA and Long-Term Care Insurance Contracts” with the Internal Revenue Service (IRS) for any distributions made from your Medicare MSA account to ensure you aren’t taxed on your MSA account withdrawals. You must file these tax forms for any year in which an MSA account withdrawal is made, even if you have no taxable income or other reason for filling a Form 1040. MSA account withdrawals for qualified medical expenses are tax free, while account withdrawals for non-medical expenses are subject to both income tax and a 50 percent tax penalty. For more information about MSA plans, visit www.medicare.gov/Publications/Pubs/pdf/11206.pdf to view the booklet “Your Guide to Medicare Medical Savings Account Plans. Tax publications are available on the IRS website at http://www.irs.gov or from 1-800-TAX-FORM (1-800-829-3676).
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.
Plan documents are available in other formats. Call Advantra Savings (MSA) at 1-800-474-5993 (TDD/TTY: 1-888-788-4010), 8 a.m. to 8 p.m., seven days a week for information about other formats.
Coordinated Care Plans (HMO/PPO/POS)
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 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.
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.
Some of our health plans offer Special Needs Plans that are available to all people with Medicare who have a diabetic condition or who have high cholesterol. If enrolling in one of these plans, you may be required to complete a Pre-Enrollment Qualification Assessment tool to verify that you have diabetes or high cholesterol. We may also verify your condition with your provider or your provider’s office. 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.
