Advantra (HMO)

Medicare Advantage Plan for Louisiana

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderCoventry Health Care of Louisiana
Plan IDH3928-1-0
CMS Rating1
Plan TypeHMO
Annual Deductible$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
$140 for days 1 through 6
$0 for days 7 through 90
Outpatient hospital coverage
$175 per visit
Doctor visits
Primary:
$5 per visit
Specialist:
$30 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$30 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
$10
Lab services:
$15
Diagnostic radiology services (e.g., MRI):
$150
Outpatient x-rays:
$25
Mental health services
$255 for days 1 through 6
$0 for days 7 through 90
Outpatient group therapy visit with a psychiatrist:
$30
Outpatient individual therapy visit with a psychiatrist:
$30
Outpatient group therapy visit:
$30
Outpatient individual therapy visit:
$30
Skilled Nursing Facility
$0 for days 1 through 20
$125 for days 21 through 100
Rehabilitation services
Occupational therapy visit:
$20
Physical therapy and speech and language therapy visit:
$20
Ambulance
$250
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
$30
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
0-20% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for Advantra (HMO)

StateLouisiana
CountyEast Baton Rouge Parish

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$2 copay$10 copay$2 copay
Tier 2: Non-Preferred Generic$5 copay$15 copay$5 copay
Tier 3: Preferred Brand Name$42 copay$47 copay$42 copay
Tier 4: Non-Preferred Brand Name$100 copay$100 copay$100 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$6 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$15 copay$45 copay$10 copay
Tier 3: Preferred Brand Name$126 copay$141 copay$121 copay
Tier 4: Non-Preferred Brand Name$300 copay$300 copay$300 copay
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Not Rated
Improving or maintaining mental health
Not Rated
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Not Rated
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
Not Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Not Rated
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

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

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical
Not Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Not Rated
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Not Rated
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept Advantra (HMO) for Louisiana

/
PEI, LEO
17000 MEDICAL CENTER DRIVE
BATON ROUGE, LA 70816
KHALID-ABASI, MUNIR
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
HOLMES, KEITH
2345 ONEAL LN
BATON ROUGE, LA 70816
SUNKARA, PALLAVI
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
JOHNSTON, FRANCIS
1940 ONEAL LN
BATON ROUGE, LA 70816
HARRIS, ANGELA
16777 MEDICAL CENTER DRIVE
BATON ROUGE, LA 70816
MORVANT, KRISTIN
16777 MEDICAL CENTER
BATON ROUGE, LA 70816
IDOWU, BEN
17050 MEDICAL CENTER DR
BATON ROUGE, LA 70816
LEA, RANDALL
17 ALICE PECK DAY DR
LEBANON, NH 03766
MUZYCHKA, DARIA
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
WAHID, SAIYID
1962 ONEAL LN
BATON ROUGE, LA 70816
NNADI, JOHN
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
SANTORO, MARY
1203 CROSSBOW DR
BATON ROUGE, LA 70816
KOZAR, BRIAN
16777 MEDICAL CENTER DR
BATON ROUGE, LA 70816
ELLIOTT, ROBERT
17050 MEDICAL CENTER DR STE 400
BATON ROUGE, LA 70816
MCCAULEY, LINDA
16777 MEDICAL CENTER DR
BATON ROUGE, LA 70816
VUONG, HIEU
3851 S SHERWOOD FOREST BLVD
BATON ROUGE, LA 70816
GESN, LOIS
2345 ONEAL LN
BATON ROUGE, LA 70816
FLINT, CAROLINE
2345 ONEAL LN
BATON ROUGE, LA 70816
GIROD, TYRONE
5617 GALERIA DR
BATON ROUGE, LA 70816
THOMAS, JOSEPH
8415 GOODWOOD BLVD
BATON ROUGE, LA 70806
NELSON, SCOTT
10423 OLD HAMMOND HWY
BATON ROUGE, LA 70816
EDWARDS, MARK
5428 STUMBERG LN
BATON ROUGE, LA 70816
ELLIOTT, MARY
17050 MEDICAL CENTER DR STE 400
BATON ROUGE, LA 70816
SHEFFIELD, LESLIE
11408 LAKE SHERWOOD AVE N STE A
BATON ROUGE, LA 70816
Details
LEO PEI, M.D.
Phone Number
(225) 752-2470
Office Locations
17000 MEDICAL CENTER DRIVE
BATON ROUGE, LA 70816
17000 MEDICAL CENTER DRIVE BATON ROUGE LA, 70816

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