Eligibility Requirements

You are eligible to join Summit (HMO) 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. With the exception of emergency or urgent care, it will cost more to get care from out-of-network providers.  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 coinsurance in-network is based on the contracted amount which is probably lower.  Coventry provides reimbursement for all covered benefits regardless of whether they are received in-network, as long as they are medically necessary. 

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 the level of help that you receive.  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.