Frequently Asked Questions

When will my Summit (HMO) or Advantra (HMO/HMO-POS) plan be effective?

The effective date of enrollment in Summit (HMO) or Advantra (HMO/HMO-POS) will depend on (1) when Coventry receives your signed and completed enrollment form, and (2) the type of election period. We will send you a letter that tells you when your coverage begins. In general, once completed enrollment forms are received, the proposed effective date for coverage to begin will be on the first day of the following month.

There is one exception to this rule:

• Initial Election Period. When you first become entitled to both Part A and Part B of Medicare, your enrollment will be effective  the first day of the month you have coverage under both Medicare Part A and Part B.
• Annual Enrollment Period.  Elections made between November 15 and December 31 will become effective on January 1 of the following year.

Can I continue to go to my current doctors?

If you are an Summit (HMO) or Advantra (HMO/HMO-POS) member and your doctors are part of the plan's network, you can continue to go to those providers. If not, you can choose one of hundreds of providers in our network to deliver your care.

Please see your plan's Evidence of Coverage document for additional information.

I already belong to another Medicare Advantage plan. Can I switch to a Summit (HMO) or Advantra (HMO/HMO-POS) plan?

Yes. However, unless certain circumstances apply, you may change plans only during specific times of the year. As long as you are eligible, you may change to Summit (HMO) or Advantra (HMO/HMO-POS) and your other Medicare Advantage coverage will be canceled as soon as your Summit (HMO) or Advantra (HMO/HMO-POS) coverage goes into effect.

What if I decide I no longer want my Summit (HMO) or Advantra (HMO/HMO-POS) coverage?

There are only certain times during the year when you may voluntarily end your membership in our Plan. The key time to make changes is the Medicare fall open enrollment period (also known as the “Annual Election Period”), which occurs every year from November 15 through December 31. This is the time to review your health care and drug coverage for the following year and make changes to your Medicare health or prescription drug coverage. Any changes you make during this time will be effective January 1.

Certain individuals, such as those with Medicaid, those who get extra help or who move, can make changes at other times.

During Open Enrollment period each year from January 1 to March 31, you have only one chance to add, drop, or change your Medicare prescription drug coverage.

Examples:

-If you are in a MA plan that does not have Medicare prescription drug coverage, you can switch to another Medicare Advantage plan that does not offer drug coverage or go to Original Medicare.

-If you are in Original Medicare Plan and have a Medicare prescription drug plan, you can join a Medicare Advantage Plan that offers Medicare drug coverage.

-If you are in an MA plan that offers Medicare drug coverage, you can leave and join Original Medicare Plan and a Medicare prescription drug plan.

-You can disenroll from our plan at any time of the year if you are eligible for the following Special Enrollment Periods during limited special exceptions, such as:

• You have a change in Residence
• You have Medicaid
• You are eligible for extra help with Medicare prescriptions
• You live in an institution (such as a nursing home)

Generally, your disenrollment will be effective first day of next month after plan receives your disenrollment request.

For more information about the options available to you during these enrollment periods, contact Medicare at 1-800-MEDICARE (1-800-633-4227.) TTY users should call 1-877-486-2048. Additional information can also be found in the “Medicare & You” handbook. This handbook is mailed to everyone with Medicare each fall. You may view or download a copy from www.medicare.gov - under “Search Tools,” select “Find a Medicare Publication.”

Will I need to keep my Medigap policy?

No. However, a Medigap policy could be of value to you if you leave a health plan and return to traditional Medicare. If you drop your Medigap policy, or never had a Medigap policy, you might not be able to buy the policy of your choice after you have been a member of a health plan for 12 months or more, especially if you have a health problem. Before giving up your Medigap policy, you should consider discussing your particular circumstance with your state’s Health Insurance Assistance Program (SHIP) office. A listing of offices is available by calling the 1-800-MEDICARE helpline available 24 hours or the www.medicare.gov website. The services are free.

Can I be involuntarily disenrolled from Summit (HMO) or Advantra (HMO/HMO-POS)?

Members can be involuntarily disenrolled for failure to pay premiums, a permanent move outside Summit’s (HMO) or Advantra's (HMO/HMO-POS) geographic service area for six months or more, loss of Part B entitlement, fraud and/or disruptive behavior.

Can I change my Primary Care Physician once I’m enrolled?

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 (HMO) or Advantra (HMO) will be responsible for the costs. You can change primary care providers, but please contact us to verify that the provider you wish to see is part of our network.

Our Advantra POS plans allow you to see any provider within our network without referrals.  Please be sure the physician or facility you choose participates in Advantra POS. If you select a provider that does not contract with Advantra (POS), you may have to pay more. To verify his/her participation, either refer to your Advantra (POS) Provider Directory or call the Customer Service department toll-free at the number listed on your Advantra (POS) member ID card.

What isn’t covered by Summit (HMO) or Advantra (HMO/HMO-POS)?

A Medicare benefits specialist can answer specific questions for you. When you enroll, you will receive a complete list of benefits and exceptions in your plan materials, but these are the most common exclusions about which we are asked:

• Services and equipment which are not reasonable or medically necessary to treat an illness
• Plastic or cosmetic surgery unless medically necessary 
• Personal convenience items or services
• Immunizations for travel or employment
• Experimental procedures or treatments in accordance with Medicare guidelines
• Special duty nurses unless medically necessary
• Private hospital room unless medically necessary and approved by the plan in advance
• Services covered by other insurance
• Custodial care
• Benefits and services not covered by Medicare unless specifically described as a covered service in plan materials

Can my Summit (HMO) or Advantra (HMO/HMO-POS) benefit package change after I enroll?

Benefits under Summit (HMO) or Advantra (HMO/HMO-POS) are set for the calendar year (January 1 – December 31).  Our benefit package, premiums, copayments, formulary, and service area are all subject to change annually when the plan's contract with the Center for Medicare and Medicaid Services (CMS) is reviewed.  The availability of coverage beyond the end of the current contract year is not guaranteed.

Formularies can change at any time during the year.  However, you will be notified at least 60 days prior to any formulary change before the change can take effect.  No formulary change can be made by the plan during the first 90 days of each contract year.