VANTAGE HEALTH PLAN MEDICARE ADVANTAGE PREMIUM HMO-POS, HMO-POS & BASIC 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 Basic 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
$0/$30 AHN co-pay per visit

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

Emergency Room

$80 co-pay per visit – worldwide

$80 co-pay per visit – worldwide

$80 co-pay per visit – worldwide

Inpatient Hospital

$0 for day 1, $100/day for days 2-5 AHN or $100/day (days 1-5)

$325/day (days 1-5)
$225/day (days 1-5) AHN

$360/day (days 1-5)
$260/day (days 1-5) AHN

Prescription Drugs (Part D)

Tier 1 – Preferred Generics

$4 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)

Additional Benefits

Preventative Dental

100% coverage with maximum benefit of $300 every six months

100% coverage with maximum benefit of $300 every six months

100% coverage with maximum benefit of $300 every six months

Comprehensive Dental

100% coverage with maximum benefit of $300 every year for comprehensive dental

100% coverage with maximum benefit of $300 every year for comprehensive dental

Not Available

Eyewear

50% coverage with maximum benefit of $100 every year

50% coverage with maximum benefit of $100 every year

50% coverage with maximum benefit of $100 every year

 

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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