Eligibility Requirements

You are eligible to join Summit (HM0) or Advantra (HMO/HMO-POS) if:

• You are entitled to Medicare Parts A and B benefits due either to age or disability. With Summit (HMO) or Advantra (HMO/HMO-POS), you must continue to pay your Medicare Part B premium. If you do not have Medicare Part B, you are not eligible for Summit (HMO) or Advantra (HMO/HMO-POS) and must contact your nearest Social Security office and sign up for Part B.
• You live in the Summit (HMO) or Advantra (HMO/HMO-POS) service area.
• You have not been diagnosed with End-Stage Renal (kidney) Disease, unless you are already a member of Summit (HMO) or Advantra (HMO/HMO-POS) or had a successful kidney transplant.

Medicare Prescription Drug benefits are only available to beneficiaries with Part D Prescription Drug coverage or members of a Medicare Advantage Prescription Drug plan. You cannot enroll in this plan if your current or former employer helps pay for your drugs.

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 Summit or Advantra will be responsible for the costs.

Advantra POS 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 Advantra POS to pay for these services. Otherwise, neither Coventry nor Original Medicare will pay for these services. Member financial responsibility may be greater out-of-network since coinsurance is based on the Medicare-allowed amount and not on the (potentially lower) amount Advantra POS has agreed to pay to the provider.

Some Summit (HMO) or Advantra (HMO/HMO-POS) plans offer programs designed for anyone who has both Medical Assistance from the state and Medicare.  Premiums, copays, coinsurance and deductibles may vary based on your income.  Please contact the plan for details.

If you have any questions regarding eligibility requirements, simply call us toll-free at 1-877-988-3589 (1-888-788-4010 TTD/TTY), 8 a.m. to 8 p.m., seven days a week.

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, seven days a week. The TTY/TDD number is 1-877-486-2048. Domain names, trademarks and copyrights of other websites or of, or contained in, information on this website are the sole property of their respective owners.