Advantra Preferred for Burke, GA
Medicare Advantage Plan Summary & Benefits
Advantra Preferred is a Preferred Provider Organization (PPO) healthcare plan for seniors and other beneficiaries in Burke County, GA with Medicare benefits. A Medicare Advantage PPO plan gives you freedom to choose which doctors, specialists, and hospitals you visit. You can lower your costs when you use network providers. Plus, predictable copayments and coinsurance make it easier for you to budget healthcare costs.
The plan information presented on this page is a summary, but not a complete description of available benefits. Comprehensive information about the plan benefits is available from your agent.
Summary of Benefits
The information on this page is a brief summary. We recommend that you download and print the Summary of Benefits PDF document for this 2014 health plan and read it thoroughly. Please Contact an Agent or the plan if you have unanswered questions.
The monthly premium for this health insurance plan in Burke County is $0.00 plus your monthly Medicare Part B premium. Most Medicare beneficiaries pay the standard monthly Part B premium in addition to their MA or MAPD plan premium. However, some beneficiaries are required to pay slightly higher Part B and Medicare Part D premiums because of their income (over $85,000 per year for singles or $170,000 for married couples), or due to late enrollment penalties.
Part D Prescription Drug Plan Information
This plan includes prescription drug coverage. The formulary (00014271) has a total of 3,177 prescription medications.
If you have Part D assistance, your premium will be adjusted based on your percentage.
|Formulary Drug Details:||Tier 1||Tier 2||Tier 3||Tier 4||Tier 5|
|— Drugs per Tier:||767||804||350||924||332|
|— Cost-Sharing in ICP:||$3.00||$18.00||$42.00||$85.00||33%|
The Medicare Part D deductible with this health plan is $0.00. That means you have first dollar coverage.
Maximum Out of Pocket (MOOP) Benefit
The new healthcare law allows for a maximum limit of $6,700 on your out of pocket medical costs for 2014 Medicare Advantage plans. This amount is commonly called the plan MOOP (Maximum Out of Pocket). A plan's MOOP does not include your prescription drugs or the monthly premiums you pay for your health plan. Although the mandatory MOOP limit is $6,700, the Affordable Care Act law allows for a “Voluntary MOOP” that can be as low as $3,400. The MOOP on this plan is $4,400 .
Most Medicare health plans require you to make a co-payment (aka, copay) when you visit your primary care physician or a doctor. Here's how this plan works:
- $10 co-payment for each visit to your primary care physician.
- $39 co-payment for each visit to a specialist covered by Medicare.
- $40 co-payment for each visit to your primary care physician.
- $49 co-payment for each visit to a specialist covered by Medicare.
Urgent Care Doctor Visits
Urgent care is the delivery of ambulatory medical care outside of a hospital emergency department on a walk-in basis without a scheduled appointment. Here's how Urgent Care works with this plan:
- $39 co-payment for urgent care treatment covered by Medicare.
Emergency care is medical attention for patients with acute illnesses or injuries which require immediate medical attention. Here's how Emergency Care works with this plan:
- $65 co-payment for emergency room treatments covered by Medicare.
- Worldwide coverage.
- When you are to the hospital within 24-hour(s) for the same medical condition you pay $0 for the emergency room treatment.
Most health plans do not cover transportation to and from medical services. The exception, of course, is when you have an emergency or when non-ambulatory. Here's how this plan covers ambulance service:
- Pre-authorization rules apply.
- $175 co-payment for ambulance benefits covered by Medicare.
- 20% of the cost for ambulance benefits covered by Medicare.
Inpatient Treatment (Hospital Stays)
A patient who is admitted to a hospital or clinic for treatment that requires at least one overnight stay is an inpatient. Most health plans have a tiered cost structure for inpatient treatment. Here's how this plan covers hospital stays:
- There is no limit to the number of days covered by the plan per stay in the hospital.
- For hospital stay covered by Medicares:
- Days 1 - 6: $259 co-payment per day. .
- Days 7 - 90: $0 co-payment per day.
Compare Medicare Advantage Plans
Compare Advantra Preferred with these top rated Medicare Advantage Plans available in Burke County:
- Care Improvement Plus Medicare Advantage
- HumanaChoice R5826-077
- UnitedHealthcare MedicareDirect Essential
- UnitedHealthcare MedicareDirect Rx
- HumanaChoice R5826-064
Related Medicare Plans in Burke, GA
- Medicare Advantage Plans in Burke County, GA
- Georgia Medigap Medicare Supplements
- Senior Dental Insurance Available in Georgia
- Georgia Medicare Part D Prescription Drug Plans
This page was last updated on: 10/28/2013
About The Insurer Coventry Health Care
Coventry's roots can be traced back to November 21, 1986, the date the company predecessor company, Coventry Corporation, was incorporated. Coventry Health Care, Inc. became a public company in 1991, and is currently listed on the NYSE with ticker symbol CVH.
Since the company's inception, the building blocks of The Coventry Model have remained financial discipline and service excellence. The company's senior management team has long understood those two objectives need not be mutually exclusive.
The summary (overall) rating for this Coventry Health Care plan is 3.0 out of 5 based on reviews from 0 user ratings from the previous year. For more information about the review process, visit http://cms.gov.