What Types of Medicare Part D Coverage Does Coventry Offer?

Last Updated : 05/28/20196 min read

As a Medicare beneficiary, you may be interested in Medicare Part D prescription drug coverage. Coventry, a private insurance company contracted by Medicare to provide health-care benefits, offers two ways to get your Medicare Part D coverage for prescription medications. Learn how Medicare prescription drug coverage works, and find out what may work best for your situation.

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Are there Coventry Medicare Advantage plans with prescription drug coverage?

As a beneficiary, you can get Medicare Part D prescription drug coverage with many of the Medicare Advantage plans offered by Coventry. Medicare Advantage (Part C) is an alternative way to get your Original Medicare (Part A and Part B) coverage, except instead of having your benefits administered through the federal government, you’ll get them directly through your Medicare Advantage plan. Medicare Advantage plans must cover at least the same benefits as Original Medicare (except for hospice), but may also include additional coverage, such as prescription drugs.

Depending on where you live, you may be eligible to enroll in one of the following types of Coventry Medicare Advantage plans. Many of these plan types may include prescription drug coverage (also known as a Medicare Advantage Prescription Drug plan):

  • Coventry MedicareAdvantage Health Maintenance Organization (HMO) plans, which require you to use network providers for your medical care, except for medically necessary emergency treatment. You may also need to get referrals from a primary care doctor for certain specialist services.
  • Coventry Medicareplans*, which allow you to get care from both in-network and non-network providers, although your out-of-pocket costs are lower if you use providers in the plan’s network. You don’t need referrals for specialist care.
  • Coventry MedicareAdvantage Special Needs Plans (SNPs). These plans limit enrollment to individuals with certain diseases or chronic conditions; people with Medicare and Medicaid; and those who live in institutions (such as nursing homes). Benefits are catered to meet the unique needs of its members, and you must meet the eligibility criteria for the plan to enroll in the SNP.
  • Coventry MedicareAdvantage Private Fee-for-Service (PFFS) plans, which let you see any provider who accepts your plan’s payment terms and conditions and agrees to treat you. Not all providers, even if they accept Medicare, will take your Coventry Medicare Advantage PFFS plan, so be sure to ask every time before you receive medical care.

While many Medicare Advantage plans include prescription drug coverage, not all do; it’s important to check individual plan benefits before you enroll. If you want prescription drug coverage with your Coventry Medicare Advantage HMO or PPO plan, be sure it’s included in the plan you choose, because these two plan types cannot be combined with stand-alone Medicare Part D Prescription Drug Plans.

Not all Coventry Medicare Advantage plans are available in all locations, and plan benefits and premiums may differ from place to place. You must continue to pay your Part B premium, plus any additional premium required by your plan.

Are there stand-alone Coventry Medicare Part D Prescription Drug Plans?

As another option, Coventry offers stand-alone Medicare Part D Prescription Drug Plans that you can use alongside your Original Medicare (Part A and Part B) coverage. All Medicare plans that cover prescription drugs use a formulary to determine benefits; a formulary is simply a list of covered medications and the benefit amounts for each. Plans may change their formularies from time to time, but they must notify you in writing if they do.

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Some things to keep in mind about Coventry Medicare Part D Prescription Drug Plans:

  • You may be required to use network pharmacies in order to access benefits or to minimize your out-of-pocket costs.
  • Your plan may use cost-control measures such as tiered formularies, in which your costs may be lower if you use lower-tiered (often generic) medications and higher for medications on higher tiers (often brand-name ones); or quantity limits, which restrict the number of pills or doses you can obtain at one time.
  • You may pay a separate monthly premium for your Coventry Medicare Part Dprescription drug coverage, and plan premiums and benefits may vary depending on where you live.
  • Stand-alone Coventry Medicare Part DPrescription Drug Plans generally can’t be combined with most types of Medicare Advantage plans. If you want prescription drug benefits and have Medicare Part C, you should get it through a Medicare Advantage plan that includes prescription drug benefits.

You should sign up for Medicare Part D prescription drug coverage as soon as you are eligible.  If you wait to enroll in Part D and go without other creditable prescription drug benefits (insurance that pays, on average, as much as the standard Part D benefit) for 63 days in a row or more, you may have to pay a monthly late-enrollment penalty with your monthly premium for as long as you have coverage.

Hopefully, you now have a better idea of how Medicare prescription drug coverage works and the different ways you can get help paying for your medications. If you’d like help finding Coventry Medicare plan options that cover your prescription drugs, you can:

  • View the Coventry Medicare page for more information on Coventry and its wide selection of Medicare plan options.
  • Browse Medicare plan options in your zip code now by clicking on the Find Plans button on this page.

*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 at www.aetnamedicare.com or call the phone number listed in this material.
ESPAÑOL (SPANISH): ATENCIÓN: Si usted habla español, se encuentran disponibles servicios gratuitos de asistencia de idiomas. Visite nuestro sitio web en www.aetnamedicare.com o llame al número de teléfono que se indica en este material.

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