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:
2014
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$4,700 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$16.90
Monthly Health Plan Premium
$1.10

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$10 maximum per visit
Not Applicable
Specialist Office Visit
$30 maximum per visit
Not Applicable
Outpatient Services
$150 maximum per visit
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$125 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
$275 copay
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
$275 copay
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$8 copay$4 copay
Tier 2: Non-Preferred Generic$19 copay$33 copay$19 copay
Tier 3: Preferred Brand Name$34 copay$45 copay$34 copay
Tier 4: Non-Preferred Brand Name$92 copay$95 copay$92 copay
Tier 5: Specialty Tier33% coinsurance33% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$12 copay$24 copay$10 copay
Tier 2: Non-Preferred Generic$57 copay$99 copay$47.5 copay
Tier 3: Preferred Brand Name$102 copay$135 copay$85 copay
Tier 4: Non-Preferred Brand Name$276 copay$285 copay$276 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 Plus (HMO) for Pennsylvania

/
STEERMAN, PAUL
101 E OLNEY AVE
PHILADELPHIA, PA 19120
NGUYEN, KENNETH
448 E WYOMING AVE
PHILADELPHIA, PA 19120
WIMMER, ROBERT
101 E OLNEY AVE
PHILADELPHIA, PA 19120
SCHINDLER, ALAN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
ESQUENAZI, ALBERTO
101 E OLNEY AVE
PHILADELPHIA, PA 19120
MEHROTRA, DEEPAK
101 E OLNEY AVE
PHILADELPHIA, PA 19120
ROTH, JONATHAN
101 E OLNEY 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
SELBST, ALISON
101 E OLNEY AVE
PHILADELPHIA, PA 19120
LEVIN, BRUCE
410 E ROOSEVELT BLVD
PHILADELPHIA, PA 19120
VANGORE, SURYA
431 W ROOSEVELT BLVD
PHILADELPHIA, PA 19120
MATSON, DAVID
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
BRADY, PAUL
101 E OLNEY AVE
PHILADELPHIA, PA 19120
WIKOFF, EDWARD
101 E OLNEY AVE
PHILADELPHIA, PA 19120
MYERS, JOHN
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
WHYTE, JOHN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
YOO, STANLEY
101 E OLNEY AVE
PHILADELPHIA, PA 19120
Details
PAUL STEERMAN, MD
Phone Number
(215) 456-7000
Office Locations
101 E OLNEY AVE
PHILADELPHIA, PA 19120
101 E OLNEY AVE PHILADELPHIA PA, 19120

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.
1 question| 1 answer
Premium
Q:What is the TOTAL monthly premium for the Advantra Silver Plus HMO in Allegheny County, PA (15241) for the year 2014?
Asked by Anonymous 

1 answer

Know the Answer? Answer this Question
A: You may fill out your zip code, date of birth , medication, condition etc information required in the quote page, then you will get the total monthly premium there.
Answered on 1/6/2014 by Anonymous 

Similar Plans

PremiumPlan NameCMS Rating
$0.00
Today's Options Premier 700 (PFFS)
Select
$0.00
Humana Gold Choice H8145-055 (PFFS)
Select
$0.00
Geisinger Gold Reserve (MSA)
Select
$0.00
UPMC for Life HMO (HMO)
Select
$0.00
SeniorBlue - Option 3 (HMO)
Select

Related Articles

Related Searches