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Our Medicare Advantage plans are Coordinated Care plans with Medicare Advantage contracts. 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 Coventry will be responsible for the costs. For members in our PPO plans, with the exception of emergency or urgent care, it will cost more to get care from out-of-network providers. Accessing service 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 the co-insurance 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. The Medicare health plan is open to all Medicare beneficiaries eligible by age or disability in the plan’s service area. You must be entitled to Medicare benefits under Part A and enrolled in Part B, and reside in the Coventry service area. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. If you switch to premium withhold or move from premium withhold to direct bill, it can take up to three months for the switch to take effect. You will be held responsible for those premiums. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:
Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances when they cannot reasonably use network pharmacies. Medicare beneficiaries may enroll in our Medicare Advantage plans through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov. Beneficiaries may only enroll during specific times of the year, except for SNP-eligible members who may enroll at any time. For more information, contact Coventry at 1- 877-982-9123 (TTY/TDD: 1-888-788-4010 for the hearing impaired), 8 a.m. to 8 p.m., seven days a week. The Medicare program rates how well plans perform in different categories (for example, detecting and preventing illness, ratings from patients and customer service). To find plan ratings information go to http://www.medicare.gov and select "Compare Medicare Prescription Drug Plans" or "Compare Health Plans and Medigap Policies in Your Area" to compare the plan ratings for Medicare plans in your area. You can also call us directly at 1-877-982-9123 to obtain a copy of the plan ratings for this plan. TTY users call 1-888-788-4010. Exclusions and limitations may exist, contact the plan for details. For full information on Coventry benefits, call our Customer Services Department at 1- 877-982-9123 (TTY/TDD: 1-888-788-4010 for the hearing impaired), 8 a.m. to 8 p.m., seven days a week. This document is available in alternate formats and languages. For more information contact 1-877-982-9123, (TTY/TDD 1-888-788-4010 for the hearing impaired) 8 a.m. to 8 p.m., seven days a week. Page Last Updated: 03/10/2010 |
