PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Coventry Health Care
CMS Rating
Plan Type
HMO
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Plan Details

Costs and Other Important Information

Plan Year:
2013
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$6,700 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$5 maximum per visit
Not Applicable
Specialist Office Visit
$40 maximum per visit
Not Applicable
Outpatient Services
$240 maximum per visit
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$200 maximum
Not Applicable
Kidney Disease and Conditions
$0
Not Applicable
Home Health Care
$0
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Inpatient Hospital Care
Days 1-7: $200 copay per day. Days 8-90: $0 copay per day
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-5: $0 copay per day. Days 6-20: $50 copay per day. Days 21-100: $90 copay per day
Not Applicable
Inpatient Mental Health Care
Days 1-7: $200 copay per day. Days 8-90: $0 copay per day
Not Applicable

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$4 copay$4 copay$4 copay
Tier 2: Non-Preferred Generic$25 copay$25 copay$25 copay
Tier 3: Preferred Brand Name$35 copay$35 copay$35 copay
Tier 4: Non-Preferred Brand Name$85 copay$85 copay$85 copay
Tier 5: Specialty Tier33% coinsurance33% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$12 copay$12 copay$10 copay
Tier 2: Non-Preferred Generic$75 copay$75 copay$62.5 copay
Tier 3: Preferred Brand Name$105 copay$105 copay$87.5 copay
Tier 4: Non-Preferred Brand Name$255 copay$255 copay$255 copay
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Cholesterol screening for patients with heart disease
Glaucoma testing
Annual flu vaccine
Pneumonia vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Improving bladder control
Reducing the risk of falling
Plan all-cause readmissions

Ratings of Plan Responsiveness and Care

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan

Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

Complaints about the health plan
Beneficiary access and performance problems
Members choosing to leave the plan
Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability

Physician Finder

Physicians that accept Advantra Silver (HMO) for Pennsylvania

/
NGUYEN, KENNETH
448 E WYOMING AVE
PHILADELPHIA, PA 19120
SMALL, RONALD
104 W CHELTENHAM AVE
PHILADELPHIA, PA 19120
TADLEY, GERALD
335 E WYOMING AVE
PHILADELPHIA, PA 19120
BLENDER, BURTON
335 E WYOMING AVE
PHILADELPHIA, PA 19120
HOELLEIN, KENNETH
101 E OLNEY AVE
PHILADELPHIA, PA 19120
VANGORE, SURYA
431 W ROOSEVELT BLVD
PHILADELPHIA, PA 19120
ROTH, JONATHAN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
AHSAN, SYED
101 E OLNEY AVE
PHILADELPHIA, PA 19120
CLARKE, CLAUDINE
101 E OLNEY AVE
PHILADELPHIA, PA 19120
SRIDHARA, CHANNARAYAPATNA
101 E OLNEY AVE
PHILADELPHIA, PA 19120
VACHRANUKUNKIET, THEERA
101 E OLNEY AVE
PHILADELPHIA, PA 19120
ESQUENAZI, ALBERTO
101 E OLNEY AVE
PHILADELPHIA, PA 19120
CHO, SOOJA
3601 TVC
NASHVILLE, TN 37232
SCHWARTZ, HARRY
101 E OLNEY AVE
PHILADELPHIA, PA 19120
WHYTE, JOHN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
WALSH, BRIAN
4702 N 5TH ST
PHILADELPHIA, PA 19120
MEHROTRA, DEEPAK
101 E OLNEY AVE
PHILADELPHIA, PA 19120
SAMUELS, EYDA
101 E OLNEY AVE
PHILADELPHIA, PA 19120
SCHINDLER, ALAN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
WIKOFF, EDWARD
101 E OLNEY AVE
PHILADELPHIA, PA 19120
STEERMAN, PAUL
101 E OLNEY AVE
PHILADELPHIA, PA 19120
ROSENSTEIN, KENNETH
101 E OLNEY AVE
PHILADELPHIA, PA 19120
COSGROVE, DOUGLAS
101 E OLNEY AVE
PHILADELPHIA, PA 19120
LANOCE, GARY
4857 C ST
PHILADELPHIA, PA 19120
GARCIA, LAUREANO
328 W GODFREY AVE
PHILADELPHIA, PA 19120
Details
KENNETH NGUYEN, M.D.
Phone Number
(215) 324-2180
Office Locations
448 E WYOMING AVE
PHILADELPHIA, PA 19120
448 E WYOMING AVE PHILADELPHIA PA, 19120

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