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HealthTeam Advantage Cardinal Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthTeam Advantage Cardinal Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthTeam Advantage Cardinal Plan (HMO) in 2025, please refer to our full plan details page.
HealthTeam Advantage Cardinal Plan (HMO) is a HMO plan offered by HTA Holdings, LLC available for enrollment in 2025 to people living in Piedmont Triad Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that HealthTeam Advantage Cardinal Plan (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HealthTeam Advantage Cardinal Plan (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HealthTeam Advantage Cardinal Plan (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HealthTeam Advantage Cardinal Plan (HMO) has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance based on the drug tier and pharmacy used. For example, preferred generic drugs have a $5 copay at preferred pharmacies, while standard generic drugs have a $47 copay at both preferred and standard pharmacies. Once your total drug costs reach $2000, you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HealthTeam Advantage Cardinal Plan (HMO) offers a range of benefits, including inpatient hospital stays with a $195 copay for the first few days, and outpatient services like outpatient hospital services with a $225 copay. The plan also covers ambulance services, with copays of $200 for ground and $300 for air, and emergency services with a $120 copay. This plan provides coverage for primary care, hearing, vision, dental, and home infusion services. You'll find $5 copays for many primary care services, hearing exams, and eye exams. Additionally, the plan includes benefits for preventive services, and medical equipment with varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $195 copay for days 1-6, and no copay for days 7-90; additional days are covered. For Inpatient Hospital Psychiatric, you'll pay a $195 copay for days 1-8, and no copay for days 9-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $225 copay, Observation Services, Ambulatory Surgical Center (ASC) Services with a $125 copay, Individual and Group Sessions for Outpatient Substance Abuse with a $5 copay, and Outpatient Blood Services with 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the HealthTeam Advantage Cardinal Plan (HMO) with a $50 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HealthTeam Advantage Cardinal Plan (HMO). Ground ambulance services have a $200 copay, while air ambulance services have a $300 copay, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HealthTeam Advantage Cardinal Plan (HMO). Emergency Services have a $120 copay and no coinsurance, while Urgently Needed Services have a $10 copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $75,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The HealthTeam Advantage Cardinal Plan (HMO) covers primary care physician, chiropractic, occupational therapy, physician specialist, mental health specialty, other health care professional, psychiatric, physical therapy, speech-language pathology, and opioid treatment program services. Chiropractic, physician specialist, mental health specialty, psychiatric, physical therapy, and speech-language pathology services have a $5 copay, while additional telehealth benefits have a copay between $0 and $5.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, annual physical exams, and other preventive services. The plan also covers home-based palliative care, in-home support services, remote access technologies, and fitness benefits including memory fitness and activity trackers. However, this plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, support for caregivers, additional smoking cessation sessions, enhanced disease management, telemonitoring services, home and bathroom safety devices, or counseling services.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $5 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $5 copay, as well as coverage for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. The plan also covers upgrades.
Dental Services See details
The HealthTeam Advantage Cardinal Plan (HMO) covers dental services, including oral exams, dental x-rays, and other diagnostic dental services with no copay, and also covers prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. This plan has a maximum benefit of $1100 per year for Other Dental Services. Orthodontic Services are covered under Diagnostic and Preventive Dental (16b).
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HealthTeam Advantage Cardinal Plan (HMO). For Medicare Part B Insulin Drugs, there is a $35 copay, while other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HealthTeam Advantage Cardinal Plan (HMO), but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is covered, with 0-20% coinsurance for Diabetic Supplies, but Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $275, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the HealthTeam Advantage Cardinal Plan (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. A doctor referral is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services includes coverage for over-the-counter items with a maximum benefit of $145 every three months, and a meal benefit for certain medical conditions. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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