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Coventry Medicare

Coventry Medicare Update For 2017: On May 7, 2013, Coventry Health Care was purchased by Aetna for $5.6 billion. This newly merged company formed the third-largest health benefits carrier, with an estimated membership of 22 million consumers. But even before, as an independent carrier, Coventry had earned a respectable reputation within the American healthcare system. The company focuses on low-cost health insurance, providing necessary services and benefits at an affordable rate.

Today, Coventry sells Medicare policies and Affordable Care Act (ACA)-compliant health insurance to an estimated 5 million beneficiaries, including its national plan network and local health plans for 20 states. It provides policies for individuals and families as well group health plans for businesses small and large.

As with many carriers, Coventry places particular emphasis on Medicare. This isn’t surprising, given that the company already had an estimated 250,000 Medicare beneficiaries (and 930,000 on Medicaid) before the Aetna acquisition. According to Medicare’s Star Ratings, Coventry had an overall Star Rating of four stars in 2017. Coventry’s Medicare Advantage (MA) policies, among its most popular, offer the benefits of Original Medicare – Part A (hospital insurance) and Part B (medical insurance) – with Medicare Part D prescription plans (PDPs). As of March 2017, Aetna had almost 47 million subscribers.

Coventry also offers the same standalone Part D plans in all states and the District of Columbia that are offered through Aetna. Prior to the acquisition, the company already had more than 1.5 million Part D enrollees. Coventry’s prescription drug coverage plans have ranked among the industry’s best. The company also provides Medicare Supplement plans (Medigap), which require deductibles and coinsurance.

The Aetna Connection’s Benefits

Coventry was a relatively new insurer until recently, providing coverage in just 22 states. After the merger, the carrier reached all 50 states and the District of Columbia. The company has about 15,000 employees, and its network of providers includes more than 4,700 participating hospitals; 580,000 allied health care professionals; and an additional 64,000 retail pharmacies. Coventry also offers worker’s compensation and behavioral health plans, managed care products and services like provider network access, care management and durable medical equipment.

Coventry’s acquisition by Aetna has benefitted both carriers, especially for the valuable Medicare audience. Analyst Thomas Carroll noted:

“It’s a deal that almost had to happen. For Aetna to really compete effectively among the other large, national managed-care companies, they have to do more in terms of gaining market share in the commercial business, as well as getting a bigger foothold in Medicare and Medicaid, which are the growth areas in managed care over the next decade.”

Aetna gained 5 million Coventry members, including 250,000 Medicare enrollees; 1.5 million Part D enrollees; and 930,000 Medicaid enrollees. They were also able to grow their base of smaller employers and beneficiaries who purchased individual coverage.

Coventry Medicare Plans

Coventry Medicare Advantage plans at a glance.

When it comes to comparing Medicare plans, Coventry’s website takes you to the Aetna plan page. The site is not user-friendly and can be difficult to manage. Clicking on “Compare 2017 Plans and Costs” takes you to a page that requires you to enter your ZIP code and first name. You are then taken to a page with a lengthy questionnaire. Although you can skip the questionnaire, the plans may be limited and will not include prescription plans. Although the top of all plan pages say that you are looking at Coventry plans, they are actually the same plans offered by Aetna. These may include:

  • Health Maintenance Organization (HMO) – With this plan, you select a primary, in-network physician. For out-of-network provider and hospitals, you may have to pay out of pocket.
  • Preferred Provider Organization (PPO) – This plan offers greater flexibility, as you can visit out-of-network providers and hospitals, although they cost more.
  • HMO Point-of-Service (HMOPOS) – Specific to Coventry, this provides coverage for plan members through a network of locally contracted doctors and hospitals; you can also visit out-of-doctors and hospitals.

Coverage offered varies but may include:

  • Primary care visits
  • Specialists visits
  • Diagnostic tests
  • X-rays
  • Diagnostic radiologic services
  • Inpatient hospital services
  • Emergency care
  • Outpatient surgery
  • Ambulance services
  • Outpatient mental healthcare
  • Home healthcare
  • Skilled nursing facility (SNF) visits
  • Diabetes programs
  • Preventive care
  • Annual physicals
  • Fitness membership
  • Telemonitoring (remote healthcare
  • Discounts for hearing aids, vision and dental
  • Durable medical equipment (DME) – equipment meant for home use, long-lasting and medically prescribed as necessary

You should know that for certain areas, there will only be MA plans or PDPs available. And despite the partnership with Aetna (and Humana), some extras included with those plans may not be offered with Coventry policies. You still receive these plans’ basic coverage, but they may be combined with prescription drug coverage. Individual plan benefits may also differ by state. For the plans below, all have the same benefits, but there may be different costs for copays. According to Coventry’s website, only Aetna plans are now offered for Medicare.


Coventry/Aetna Medicare Value Plan HMO

This HMO offers an affordable option for those without a preferred provider. You can pick a primary care physician, but you must stick with in-network providers and facilities to avoid most out-of-pocket costs. It covers all of original Medicare’s services, and prescription drug coverage is also available.


Coventry/Aetna Medicare Standard Plan PPO

This plan allows you to visit out-of-network providers and facilities, but there may be additional costs for going outside the network. Members don’t have to select a primary care physician. This PPO has the same benefits as the HMO plan, although certain extras like vision, dental and hearing benefits are not available.


Standalone Prescription Drug Plans PDP

Aetna offers PDPs that are beneficial if you already have original Medicare. However, these plans have higher monthly premiums.


Coventry/Aetna CVS/Pharmacy Prescription Drug Plan

If you have original Medicare but require different, multiple or generic drugs each month, this PDP may be most beneficial.


Coventry/Aetna Medicare Rx Premier Plan

With this prescription drug plan, you don’t have to pay an annual deductible. You can also select any pharmacy for your prescriptions as long it’s within your network.

As of December 31, 2016, Aetna’s healthcare network included a wide range of national and international professionals and facilities. This includes:

  1. Over 1 million healthcare professionals
  2. More than 664,301 primary care doctors and specialists
  3. 5,667 hospitals

Overview of Coventry Medicare Advantage

Coventry Health Care does a good job of providing various types of Medicare Advantage and prescription drug plans. You can choose between PPO, HMO and POS plans in most regions where Coventry is offered.

With HMO plans, you must see in-network providers and hospitals unless it’s an emergency situation. PPOs offer more flexibility, allowing you to go out-of-network, but you’ll see higher out-of-pocket costs if you see providers outside the network. The HMO Point-of-Service plans (HMOPOS) allow you to work with a network of local doctors and hospitals. You can also use a provider who isn’t in the network for some specific services.

Getting Medicare with Coventry

The Coventry website provides extensive information for non-Medicare plans. However, when it comes to Medicare plans, clicking on the button to compare plans takes you to the Aetna website.

On the Coventry page, click on “Compare Plans & Enroll.” You’ll be taken to a screen that allows you to attend a sales meeting, schedule a call, schedule an in-home visit or order an information kit. You can also choose “Compare 2017 plans & costs.” Clicking that button will take you to another screen where you can choose plans offered by an employer or plan sponsor, medical care with or without prescriptions drugs, prescription drugs only, or supplements to original Medicare. Clicking on any of those options will take you to various screens that request information about where you live, either the state or ZIP code. Some screens also ask for your first name.

After entering your state or ZIP code, you may be taken to a screen with an online questionnaire with multiple parts. The questions ask insurance-related questions like age, health conditions, prescription drug names and more. You do have the option to skip this step at the bottom of the screen. Once you have passed the questionnaire, the site displays the plans available. More than likely, you will be given a few options in Medicare Advantage as well as a few in the standalone prescription drug plan options. If you did not complete the questionnaire or did not provide prescription information, Aetna/Coventry will not calculate your drug costs as part of your plan comparison.

Coventry Medicare Rating

Coventry plans have a high Medicare program rating. These ratings are based on customer satisfaction, long-term care, customer surveys, prescription drug coverage and customer service. Plans aren’t available in all states, so the rating will likely depend on where you live. For 2017, Coventry received a weighted overall score of 4 stars (out of 5) for its Medicare Advantage Prescription Drug (MAPD) plans. According to the company’s website, 91 percent of their customers are enrolled in a plan that’s rated 4 stars or higher, which represents a 4 percent increase over 2016 enrollment. In general, costs are low for prescription drug coverage, but Coventry has a smaller network of doctors, pharmacies and facilities than other major health insurance providers. If you’re looking for some of the extras, like fitness programs, dental, vision and hearing, you won’t find those services with Coventry. Their coverage mimics original Medicare almost completely, except that they include prescription drug coverage for less than you might pay elsewhere. If you do decide to buy standalone prescription drug coverage, then you will likely spend more per month.