Top Image
 

Frequently Asked Questions about Advantra Freedom


Frequently Asked Questions about Medicare

What is Advantra Freedom?

Advantra Freedom is a Medicare Advantage Private Fee-For-Service Plan (PFFS) offered through a contract with the Centers for Medicare and Medicaid Services (CMS) -- the federal agency that administers Medicare. Advantra Freedom gives you the flexibility of private insurance but at a lower cost. Advantra Freedom can provide you with every benefit to which you are entitled under Medicare Parts A and B, including the following:

  • No deductibles.
  • Predictable copays for most services.
  • The comfort of seeing your own doctors as long as they accept Advantra Freedom's terms and conditions of payment.
  • Flexibility of no referrals.
  • Contributions towards eyeglasses, hearing aids and preventive dental care.
  • No copays for important preventive screening tests and physical exams.
  • Full coverage while traveling anywhere in the United States.
  • Registered Nurses on call 7 days a week, 24 hours a day, even on holidays.

Advantra Freedom premiums, copays and benefits may vary by county. For complete details about the plans available to you, review the Summary of Benefits or contact Advantra Freedom toll-free
1-800-711-1607, TTY/TDD users should call 1-888-788-4010, 8:00 a.m. - 8:00 p.m., local time, seven (7) days a week.

Back To Top
 

How does Advantra Freedom work?

Advantra Freedom pays your physician and hospital the same as traditional Medicare. Most doctors should agree to Advantra Freedom payment terms, but it is smart to ask in advance. You never need a referral with Advantra Freedom - you decide which doctors to see. There are no network restrictions or minimal prior authorization* requirements . Simply show your ID card at the time of service to let the provider know you are a member of Advantra Freedom.

Your annual costs are capped so you can rest easier knowing the maximum you will pay out of pocket no matter how many covered medical services you need. And with fixed copays for many services - some as low as $0 - your costs are more predictable eliminating many surprise bills.

* Prior authorization is required for procedures that must be performed at Medicare approved facilities such as transplants or carotid artery stenting. Because some drugs may be covered under either Part B or Part D depending upon the situation, Advantra Freedom requires prior authorization on all Part B drugs to ensure that claims are submitted appropriately.

Back To Top
 

What does Advantra Freedom cover?

You can count on Advantra Freedom to provide the preventive care and wellness benefits that you need. You are covered 100%* for preventive care such as:

  • Annual physical exams
  • Immunizations
  • GYN exams
  • Screening mammograms
  • Bone mass measurements
  • Colorectal screening exams
  • Prostate screening exams
* Medicare coverage guidelines apply.

Advantra Freedom makes better vision and hearing more affordable with low copays for routine exams and with a $100 benefit towards your eyewear and hearing aids for calendar year 2009.

You even save on preventive dental care where you pay only 50% of usual and customary fees for preventive dental services such as cleanings, check-ups, and dental x-rays.

Back To Top
 

How am I covered under Advantra Freedom if I am traveling?

You are covered wherever you go with Advantra Freedom. Should you need medical care while you are traveling throughout the United States, you are eligible for full benefits — not just emergency care — from any provider who accepts Medicare's and Advantra Freedom's terms and conditions of payment. Be sure to bring along your Advantra Freedom ID card and present it at the time of service.

If your travels take you out of the country, you are covered for urgent or emergency services that would have been covered by Original Medicare — anywhere in the world. You are responsible for the same copays as if the care had been rendered in the United States.

How am I covered if I spend several months of the year in another location?

If you spend several months of the year in another location, your Advantra Freedom benefits accompany you. Unlike other Medicare plans that restrict coverage to a certain network or geographic area, you have the freedom to use any Medicare provider who accepts Advantra Freedom's terms and conditions of payment, any time, anywhere in the United States. There’s no need to switch plans or even notify us in advance unless you will be out of the service are for more than 6 months. If you will be out of the service area for more than 6 months, please contact Customer Service.

Prospective members should call 1-800-711-1607, TTY/TDD users should call 1-888-788-4010, 8:00 a.m. - 8:00 p.m., local time, seven (7) days a week.

Current Members should call Customer Service at 1-866-386-2330, 8:00 a.m. - 10:00 p.m. ET, Monday-Friday. TTY/TDD users should cal 1-866-386-2335. From November 15 - March 1, additional Saturday hours, 8:00 a.m. - 4:00 p.m. ET.

Back To Top

 

Why should I choose an Advantra Freedom Plan?

Advantra Freedom is offered through the following Coventry Health Care, Inc subsidiaries: Coventry Health and Life Insurance Company, Cambridge Life Insurance Company and First Health Life & Health Insurance Company, who contract with the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare. Coventry Health Care, Inc., one of the nation’s respected insurance carriers, currently covers close to four million Americans, including many Medicare beneficiaries. You can trust Coventry to deliver the benefits and service you need at a cost you can afford.

  • The strength and stability of more than 25 years of health care experience.
  • Predictable monthly medical expenses.
  • The comfort of seeing your own doctors as long as they accept Advantra Freedom's terms and conditions of payment.
  • Flexibility of no referrals.
  • Optional prescription plans that offer an extensive preferred medication list and more than 60,000 network pharmacies.
  • Customer service that fits your schedule.
  • A plan that’s easy to use with minimal paperwork.

You will experience the peace of mind that comes from knowing you are protected should your health care needs change.

Back To Top
 

What should I consider when selecting a plan that’s right for me?

Advantra Freedom offers you many advantages in terms of choice, coverage and savings. When selecting a Medicare Advantage plan, you should consider the trade-offs between the copay amount at the time of service, the monthly premium, the range of covered services including preventive care and wellness benefits, and the freedom to use the doctors and hospitals of your choice who accept Medicare and agree to accept Advantra Freedom's terms and conditions of payment.

When can I enroll in Advantra Freedom?

The Federal Government now limits enrollment into Advantra Freedom and other Medicare Advantage plans with or without Medicare prescription drug coverage to specific times of the year except under special circumstances.

You are eligible to join Advantra Freedom if you are entitled to Medicare Part A and are enrolled in Medicare Part B and reside within the plan’s service area. Please note the following important enrollment dates as they apply to you:

  • When you first become eligible for Medicare, you can join Advantra Freedom during the three months before or after your 65th birthday or when you are first eligible for Medicare. Your enrollment will be effective either when you are first eligible for Medicare or the first of the month after you sign up.
  • If you are already Medicare-eligible, you can join Advantra Freedom during the annual Open Enrollment Period from 11/15 to 12/31 each year. Your coverage will be effective on 1/1.
  • You can make one selection into or out of a Medicare Advantage plan from 1/1 to 3/31 each year. Your coverage would generally be the first of the month following Advantra Freedom’s receipt of your application.
  • If you move out of your current plan’s service area or lose other group coverage — you can switch to Advantra Freedom at the time of your move.

Medicare-eligible beneficiaries with limited income and resources may qualify for special assistance. People under age 65 with certain disabilities may also be eligible to join Advantra Freedom. Call your local Social Security Office for more information.

The Effective Date of enrollment in Advantra Freedom will depend on when Advantra Freedom receives your signed and completed enrollment form, and the type of election period. Advantra Freedom will send you a letter that tells you when your coverage begins. In general, completed enrollment forms must be received by Advantra Freedom by the end of the month to be effective the first of the next month.

The exception is during your Initial Election Period. (This is when you first become entitled to both Medicare Part A and Part B.) Your enrollment will be effective as of the first day of that month you have coverage under both Medicare Part A and Part B.

Back To Top
 

Why enroll in Advantra Freedom now?

If you sign up within 90 days of your Medicare eligibility date (newly-turned 65) or during the annual Open Enrollment Period (already turned 65), you will enjoy the benefits of Advantra Freedom coverage right away. Otherwise, you will have to wait until the next Open Enrollment Period starting on 11/15/08 to sign up.

Back To Top
 

I already belong to another Medicare Advantage plan. Can I switch to Advantra Freedom?

Yes. You can switch to Advantra Freedom during the annual Open Enrollment period from 11/15/08 to 12/31/08. Under special circumstances, such as if you move out of your current plan’s service area or lose other group coverage, you can switch to Advantra Freedom immediately as long as you are eligible. You can also make one selection into or out of a Medicare Advantage plan from 1/1 to 3/31 each year. Your coverage would generally be the first of the month following Advantra Freedom’s receipt of your application. Your other Medicare Advantage coverage will be canceled as soon as your Advantra Freedom coverage goes into effect.

Back To Top
 

What if I decide to terminate my Advantra Freedom coverage?

If you decide to terminate your Advantra Freedom coverage, you may “disenroll.” You can disenroll because you have decided that you wish to change Medicare plans; however, starting in 2006, there is a new law that governs when and how often you can change plans and what choices you can make when you make the changes. (See "When can I enroll in Advantra Freedom?")

There are also several situations where you would no longer be eligible for the plan’s benefits:

  • If you permanently move out of the plan’s geographic service area, or
  • If the plan leaves the Medicare program.

You may use any of the following ways to terminate your Advantra Freedom coverage:

  • Write a letter or fill out a disenrollment form. Send it to the Advantra Freedom Enrollment Department at, PO Box 7765, London, KY 40742-9833 or fax it to 1-866-906-1204.
  • Call Customer Service at 1 (800) 386-2330, 8:00 a.m. to 10:00 p.m.; ET Monday through Friday. TTY/TDD users should call 1 (866) 386-2335. From November 15, 2008 - March 15, additional Saturdays hours from 8:00 a.m. - 10:00 p.m. ET or visit www.advantrafreedom.com
  • Call 1-800 Medicare (1 (800) 633-4227) or TTY users should call 1 (877) 486-2048, 24 hours a day, 7 days a week.

In most cases, your disenrollment date will be the 1st day of the month that comes after the month we receive your request to disenroll. For example, if we receive your request to disenroll during the month of February, your disenrollment date will be March 1.

Back To Top
 

Can I be involuntarily disenrolled from Advantra Freedom?

Members can be involuntarily disenrolled for failure to pay premiums, a permanent move outside Advantra Freedom’s geographic service area for six months or more, fraud and/or disruptive behavior.

Back To Top
 

What isn't covered by Advantra Freedom?

A Medicare Benefits Specialist can answer specific questions for you. When you enroll, you will receive a complete list of benefits and exceptions in your plan materials, but these are the most common exclusions about which we are asked:

  • Services and equipment which are not reasonable or medically necessary to treat an illness
  • Plastic or cosmetic surgery unless medically necessary
  • Personal convenience items or services
  • Meals delivered to the home
  • Immunizations for travel or employment
  • Experimental procedures or treatments in accordance with Medicare guidelines
  • Special duty nurses unless medically necessary
  • Private hospital room unless medically necessary and approved by Advantra Freedom in advance
  • Services covered by other insurance
  • Custodial care
  • Benefits and services not covered by Medicare unless specifically described as a covered service in Advantra Freedom plan materials
Back To Top
 

Can my Advantra Freedom benefit package change after I enroll?

Advantra Freedom’s benefit package, premiums, copays, formulary and service area are effective for the benefit year starting 1/1 and ending on 12/31. Advantra Freedom’s contract with the Center for Medicare and Medicaid Services (CMS) is renewed annually at which time benefits, cost sharing, exclusions and service areas are subject to change for the next benefit year.

Back To Top
 

Can Advantra Freedom premiums be deducted from Social Security checks?

Yes. You have the option to have the premium deducted from your Social Security check (just like your Part B premium). Or, you or your former employer can pay the premium directly to Advantra Freedom either by check or an automatic fund transfer process. Social Security withhold option is not available to members enrolled in employer group plans.

Back To Top
 


Frequently Asked Questions about Medicare

For more information on Medicare coverage, visit www.medicare.gov or call 1-800-Medicare (1-800-633-4227). TTY for the hearing impaired 1-877-486-2048. 24 hours a day, seven days a week. Another useful resource is the CMS publication Medicare and You. This publication is located at www.medicare.gov and www.medicare.gov/publications

Who does Medicare cover?

  • People age 65 and over
  • People under 65 with certain disabilities
  • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Back To Top
 

What does Medicare Cover?

Part A is insurance covering most inpatient hospital care or hospitalization, skilled nursing facility care, home health care, and hospice care. Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.

Part B is insurance for outpatient and doctors’ services. Part B also covers some physical and occupational therapist services, and some home health care. Most people pay a monthly premium for Part B which is deducted from your Social Security check.

Part C refers to Medicare Advantage plans. Part C plans, like Advantra Freedom, provide additional benefits to Parts A and B. This means you will have all Part A and B benefits and possible Part D benefits with a range of premium options.

Prescription Drug Coverage, also known as Medicare Part D, provides coverage for some of your prescription drugs. Most people will pay a monthly premium for this coverage.

Back To Top
 

What isn’t covered by Medicare Part A and Part B?

Medicare doesn’t cover everything. Items and services that aren’t covered include, but aren’t limited to:

  • Acupuncture.
  • Deductibles, coinsurance, or copayments when you get health care services.
  • Dental care and dentures (with only a few exceptions).
  • Cosmetic surgery.
  • Custodial care (help with bathing, dressing, using the bathroom, and eating) at home or in a nursing home.
  • Eye refractions.
  • Health care you get while traveling outside of the United States (except as listed on page).
  • Hearing aids and hearing exams for the purpose of fitting a hearing aid.
  • Hearing tests (other than for fitting a hearing aid) that haven’t been ordered by your doctor.
  • Long-term care, such as custodial care in a nursing home.
  • Orthopedic shoes (with only a few exceptions).
  • Prescription drugs — most prescription drugs aren’t covered.
  • Routine foot care such as cutting of corns or calluses (with only a few exceptions).
  • Routine eye care and most eyeglasses.
  • Routine or yearly physical exams. (Medicare will cover a one-time physical exam within the first six months you have Part B.)
  • Screening tests and screening laboratory tests except those specifically identified by Medicare. See Medicare and You for more details www.medicare.gov.
  • Shots (vaccinations) except those specifically identified by Medicare. See Medicare and You for more details - www.medicare.gov.
  • Some diabetic supplies, such as syringes or insulin (unless the insulin is used with an insulin pump). These items may be covered under a Medicare Prescription Drug Plan.
Back To Top
 

What are my options?

The Original Medicare Plan—This is a fee-for-service plan that covers many health care services and certain drugs. You can go to any doctor or hospital that accepts Medicare and agrees to accept Advantra Freedom's terms and conditions of payment. The following question in this document describes the Original Medicare Plan, including how it works, what your costs are, and how you can buy a Medigap (Medicare Supplement Insurance) policy and join a Medicare Prescription Drug Plan to cover costs not covered in Original Medicare.

Medicare Advantage Plans and Other Medicare Health

Plans—These plans, which include HMOs, PPOs, private-fee-for-service (PFFS) and medical savings account (MSA),  plans, may cover more services and have lower out-of-pocket costs than the Original Medicare Plan. However, in some plans, like HMOs, you may only be able to see certain doctors or go to certain hospitals.

Medicare drug plans—Medicare prescription drug coverage started January 1, 2006. You can get prescription drug coverage no matter how you get your Medicare health care.

Back To Top
 

What is the Original Medicare Plan?

The Original Medicare Plan is one of your health plan choices as part of the Medicare Program. You will stay in the Original Medicare Plan unless you choose to join a Medicare Advantage Plan or other Medicare Health Plan.

The Original Medicare Plan is a fee-for-service plan that is managed by the Federal Government. The rules for how the Original Medicare Plan works are below.

  • You use your red, white, and blue Medicare card when you get health care
  • If you have Medicare Part A, you get all Part A-covered services
  • If you have Medicare Part B, you get all Part B-covered services. You usually pay a monthly premium for Part B
  • You can go to any doctor or supplier that accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.
  • You pay a set amount for your health care (deductible) before Medicare pays its part. Then, Medicare pays its share, and you pay your share (coinsurance or copayment) for covered services and supplies (unless you have a Medigap policy).
  • For more detailed information about Medicare-covered items and services, visit www.medicare.gov on the web, or call 1-800-MEDICARE (1-800-633-4227) to get a free copy of Your Medicare Benefits (CMS Pub. No. 10116).
Back To Top
 

What things should I consider when choosing Medicare coverage

  • Cost—What will you pay out-of-pocket, including premiums?
  • Benefits—Are extra benefits and services, like additional drug coverage, eye exams or hearing aids covered? (These may be covered by some plans.)
  • Doctor and hospital choice—Can you see the doctor(s) you want to see? Do you need a referral to see a specialist? Can you go to the hospital you want?
  • Convenience—Where are the doctors offices? What are their hours? Is there paperwork? Are they accepting new patients? Do you spend part of each year in another state?
  • Prescription drugs—Are they covered? Are your prescription drugs on the plan’s list of covered drugs (formulary)?
  • Pharmacy choice—Can you use the pharmacy you want? Are the pharmacies convenient?
  • Quality of care—How is the quality of the plans in your area? Information about quality is available at www.medicare.gov on the web.

What is “assignment” in the Original Medicare Plan and why is it important?

Assignment is an agreement between people with Medicare, their doctors and other providers, and Medicare. The person with Medicare agrees to let the doctor or other provider request direct payment from Medicare for covered Part B services, items, and supplies. Doctors or providers who agree to (or must by law) accept assignment from Medicare can’t try to collect more than the Medicare deductible and coinsurance amounts from the person with Medicare, their other insurance, or anyone else.

If assignment isn’t accepted, doctors and providers may charge you more than the Medicare-approved amount. For most services, there is a limit on the amount over the Medicare-approved amount your doctors and providers can bill you. The highest amount of money you can be charged for a Medicare covered service by doctors and other providers who don’t accept assignment is called the limiting charge. The limiting charge is 9.25% over the Medicare fee schedule. The limiting charge applies only to certain services and doesn’t apply to supplies and items. In addition, you may have to pay the entire charge at the time of service. Medicare will send you its share of the charge when the claim is processed.

In some cases, your health care providers and suppliers must accept assignment. For example, if you get Medicare Part B-covered prescription drugs and biologicals from a pharmacy or supplier that is enrolled in the Medicare Program, the pharmacy or supplier must accept assignment.

Caution: If you get your Medicare Part B-covered prescription drugs or supplies from a supplier or pharmacy not enrolled in the Medicare Program, you may have to file your own claim for Medicare to pay. Doctors and other providers generally have to submit your claim to Medicare.
For glucose test strips, all enrolled pharmacies and suppliers must submit the claim and can’t charge you for this service.

Back To Top
 



Need Help?

Para información en español, por favor de llamar gratis al 1 (800) 711-1607. TTY/TDD: 1-888-788-4010,
siete dias a la semana de 8:00 a.m. a 8:00 p.m. hora local.




We hope this website will help you understand Medicare coverage options, including Advantra Freedom.

With all of the information available on the topic of Medicare health plans, it can be confusing. We have organized this website to help you cut through some of the clutter.

Atop every “page” of this website, you will find five “navigational bars” that organize content into simple sections to help you.

Advantra Freedom Plans identifies the products available in your service area including a plan overview, benefit highlights, premiums and out-of-pocket costs. View the states and counties where Advantra Freedom is available and more.

Enrollment features forms and instructions on how to enroll. Now you can enroll online to save time!

Understanding PFFS explains Medicare Advantage Private Fee-For-Service (PFFS) in a Question and Answer format.

Contact Us contains important phone numbers and addresses for prospective and existing members, providers and brokers.

About Coventry offers background information on our company, Coventry Health Care, Inc.

Get Adobe Reader™ 

To view and print PDF files, download and install the latest version of Adobe Reader.

Back To Top