What Medicare Advantage Plans Does Coventry Offer?
This article was updated on: 11/30/2016
Medicare Advantage plans are an attractive alternative way to get Original Medicare (Part A and Part B) benefits for beneficiaries who want the convenience of getting their Medicare benefits through a single plan. Medicare Advantage plans are required by law to cover the same services as Original Medicare (except for hospice care, which is still covered through Original Medicare), but many also include prescription drug coverage, as well as other benefits such as wellness programs, routine dental, and/or vision care.
What Coventry Medicare Advantage plans are available?
While there are many different types of Medicare Advantage plans, not all plans are available in every location. Plan benefits and premiums will vary by location, and each Medicare-approved private insurance company decides which plans it will offer. Coventry Medicare Advantage plans may include the following types:
Coventry Medicare Advantage
Health Maintenance Organizations, or HMOs, are usually one of the most affordable Medicare Advantage plans because the Medicare-contracted insurance company negotiates its rates with a network of doctors and other health-care providers to treat its plan members. Here are some features of an HMO:
- Unless you need emergency care, you can only use doctors and hospitals in your plan network.
- You may need to choose a primary care doctor who is responsible for overseeing all of your health care. This means you may need a referral to see a specialist.
- Many Medicare Advantage HMOs include prescription drug coverage.
- If you get your care outside the plan network or don’t follow plan rules, such as using non-network providers, you may have to pay the full cost of your care (except for emergency or urgent care).
Coventry Medicare Advantage
The HMO POS (Point-of-Service) plan is almost identical to the basic HMO plan, except it allows you to use out-of-network providers for certain services. If you go out of network, you typically pay a higher share of the cost sharing. You may still need to select a primary care doctor and follow all other plan rules.
A PPO, or Preferred Provider Organization*, plan lets members choose to get their care from any doctor or hospital they choose, but often offers significant cost savings if they use in-network providers. Other characteristics of a PPO include:
- You do not need a primary care physician and, in most cases, you do not need a referral to see a specialist.
- Most Medicare Advantage PPOs include prescription drug coverage.
Coventry Medicare Advantage
A PFFS (Private Fee-for-Service) plan typically does not have a provider network; instead, members can use any doctor or hospital they choose that accepts Medicare and agrees to treat you under the payment terms of your plan. A PFFS plan may or may not include prescription drug coverage; if it does not, you will need to enroll in a Medicare Prescription Drug Plan if you want coverage for prescription drugs. Things you should know about a PFFS plan:
- Unless you need emergency care, a provider is not required to treat you or accept your PFFS plan for payment. Before you get care, show your plan ID and make sure the provider will treat you under your plan terms, even if they’ve provided services to you in the past. A doctor or hospital can decide at each visit whether or not to accept your PFFS plan.
- Some PFFS plans contract with a network of providers that will always treat you, even if you have never seen them before. Out-of-network providers are not obligated to treat you, even if they accept Medicare.
- If the provider contracts with the PFFS plan, you are only obligated to pay your copayment and any allowable coinsurance at the time you receive treatment.
As you can see, you may have many Coventry Medicare Advantage plan options available in your location, and it’s important to find coverage that works for your specific health needs, budget, and preferences. To learn more about Coventry Medicare plan options, click on the Coventry Medicare page. Or, if you like, you can start comparing plan options in your location now with the Find Plans button on this page. Would you rather get one-on-one assistance? Just pick up the phone and call us to reach a licensed insurance agent at the phone number below.
Call licensed insurance agents to learn about Coventry plans at 1-844-847-2659, TTY users 711; Monday through Friday, 8AM to 8PM ET.
*Out-of-network/non-contracted providers are under no obligation to treat Coventry plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
**Aetna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than English, free language assistance services are available. Visit our website atwww.aetnamedicare.com or call the phone number listed in this material.
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