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

$3,000

$5,500

$6,700

Office Visit
Primary Care/ Specialist

$10 or $0 AHN copay
and $40 or$30 AHN*
co-pay per visit

$15 or $5 AHN copay
and $45 or $35 AHN*
copay per visit

$15 or $5 AHN copay and $45 or $35 AHN* 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

$250/day or $150/day AHN* for days 1-7

$270/day or $170/day AHN* for days 1-7

$290/day or $190/day AHN* for days 1-7

Prescription Drugs (Part D)

Tier 1 – Preferred Generics

$4 copay

$4 copay

$6 copay

Tier 2 – Generics

$12 copay

$12 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 $435 deductible

Tier 5 – Specialty

33% coinsurance

28% coinsurance, after $275 deductible

25% coinsurance, after $435 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 $600 every year for comprehensive dental

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

100% coverage with maximum benefit of $300 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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