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

$3,500

$4,900

$5,900

Office Visit
Primary Care/ Specialist

$0 Primary Care copay and $40 or $25 AHN* Specialist co-pay per visit

$0 Primary Care copay and $45 or $35 AHN* Specialist copay per visit

$0 Primary Care copay and $50 or $35 AHN* Specialist copay per visit

Emergency Room

$90 ER copay per visit – worldwide coverage; waive if admitted

$90 ER copay per visit – worldwide coverage; waive if admitted

$90 ER copay per visit – worldwide coverage; waive if admitted

Inpatient Hospital

100% coverage after $250 copay per day for days 1-7 or $0 copay for day 1, $250 copay per day AHN* for days 2-7

100% coverage after $270 copay per day for days 1-7 or $0 copay for day 1, $270 copay per day AHN* for days 2-7

100% coverage after $318 copay per day for days 1-7 or $0 copay for day 1, $318 copay per day AHN* for days 2-7

Prescription Drugs (Part D)

Tier 1 – Preferred Generics

$5 copay

$5 copay

$7 copay

Tier 2 – Generics

$14 copay

$14 copay

$15 copay

Tier 3 -Preferred Brand

$47 copay

$47 copay

$47 copay

Tier 4 – Non-Preferred Brand

$100 copay

$100 copay, after $275 deductible

$100 copay, after $445 deductible

Tier 5 – Specialty

33% coinsurance

28% coinsurance, after $275 deductible

25% coinsurance, after $445 deductible

Additional Benefits

Preventative Dental

100% coverage with maximum benefit of $700 every six months

100% coverage with maximum benefit of $500 every six months

100% coverage with maximum benefit of $150 every six months

Comprehensive Dental

100% coverage with maximum benefit of $1,000 every year for comprehensive dental

100% coverage with maximum benefit of $600 every year for comprehensive dental

100% coverage with maximum benefit of $400 every year for comprehensive dental

Routine Hearing Exam

100% coverage with maximum benefit of $40 every year

100% coverage with maximum benefit of $40 every year

100% coverage with maximum benefit of $40 every year

Eyewear

0% coinsurance with maximum benefit of $200 every year

0% coinsurance with maximum benefit of $200 every year

0% coinsurance with maximum benefit of $200 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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