VANTAGE HEALTH PLAN MEDICARE ADVANTAGE PREMIUM HMO-POS, HMO-POS & ZERO-PREMIUM HMO-POS

For retirees who are 65 and over, Vantage offers several great Medicare Advantage plans as an alternative to Medicare.

One benefit to Vantage’s Medicare Advantage plans is that a network of providers is already contracted with the plan throughout Louisiana. These physicians, hospitals and specialty medical facilities have already agreed to provide health care services to treat Medicare Advantage members.

Covered Benefit

Vantage Premium HMO-POS

Vantage HMO-POS PLAN

Vantage Zero Premium HMO-POS

Plan Year Deductible

N/A

N/A

N/A

Maximum Out-of-Pocket Expense

$2,000

$3,000

$6,700

Office Visit
Primary Care/ Specialist

$5/$20 co-pay per visit or
$0/$10 AHN co-pay per visit

$10/$40 co-pay per visit or

$15/$50 co-pay per visit or
$5/$40 AHN co-pay per visit

Emergency Room

$50 co-pay per visit – worldwide

$75 co-pay per visit – worldwide

$75 co-pay per visit – worldwide

Inpatient Hospital

$50/day (days 1-5)

$300/day (days 1-5)
$150/day (days 1-5) AHN

$345/day (days 1-5)
$200/day (days 1-5) AHN

Prescription Drugs (Part D)

Tier 1 – Preferred Generics

$5 co-pay

$4 co-pay

$4 co-pay

Tier 2 – Non-Preferred Generics

$10 co-pay

$10 co-pay

$10 co-pay

Tier 3 -Preferred Brand

$25 co-pay

$47 co-pay

$47 co-pay

Tier 4 – Non-Preferred Brand

$50 co-pay

$100 co-pay

$100 co-pay (after $125 deductible)

Tier 5 – Specialty

20% coinsurance

33% coinsurance

25% coinsurance
(after $125 deductible)

 

VANTAGE MEDICAL HOME HMO RESOURCES

Vantage Health Plan

1-888-823-1910

8:00 AM – 8:00 PM CT, Mon – Fri

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