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Covenant Health Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Covenant Health Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Covenant Health Advantage (HMO) in 2025, please refer to our full plan details page.
Covenant Health Advantage (HMO) is a HMO plan offered by Baylor Scott & White Holdings available for enrollment in 2025 to people living in West Texas. The overall rating for this plan is not yet available for 2025.
It's important to know that Covenant Health Advantage (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Covenant Health Advantage (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 Covenant Health Advantage (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. Additionally, this plan comes with a Part B Premium reduction of $50.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5600.00 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:
Sign up for Covenant Health Advantage (HMO)
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Drug Coverage
Prescription drugs are not covered by Covenant Health Advantage (HMO).
Additional Benefits
The Covenant Health Advantage (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with varying copays, outpatient services with copays and coinsurance, and partial hospitalization with a $40 copay. Emergency and urgent care services have copays, and primary care visits have copays ranging from $20 to $45. This plan includes coverage for preventive services, hearing exams with a $40 copay, vision services with a $40 copay for routine eye exams, and dental services with a $2,500 annual maximum. Additional benefits include home infusion services, dialysis services with 20% coinsurance, and medical equipment with 20% coinsurance. The plan also covers skilled nursing facility stays with no copay for the first 20 days and a $214 copay per day for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you'll pay a $325 copay for days 1-6 and a $0 copay for days 7-90, with additional days and non-Medicare covered stays not covered. For Inpatient Hospital Psychiatric, you'll pay a $318 copay for days 1-5 and a $0 copay for days 6-90, and additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a $275 copay and 20% coinsurance, observation services with 20% coinsurance, ambulatory surgical center services with a $250 copay, and outpatient substance abuse services with a $45 copay for individual and group sessions. Outpatient blood services are covered with 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Covenant Health Advantage (HMO) plan, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Covenant Health Advantage (HMO). Ground and Air Ambulance Services have a $265 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Services, are covered under the Covenant Health Advantage (HMO) plan. Emergency Services have a $120 copay, while Urgent Services have a $50 copay, and both have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $5,000.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $20 copay, while Occupational Therapy Services, Individual and Group Mental Health and Psychiatric Sessions, and Opioid Treatment Program Services have a $35 copay. Physical Therapy and Speech-Language Pathology Services have a $35 copay, and Physician Specialist Services have a $30 copay. Other Health Care Professional services have a $45 copay.
Preventive Services See details
The Covenant Health Advantage (HMO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $40 copay, as well as fitting/evaluation for hearing aids, and prescription hearing aids (all types) with a plan maximum of $1000 every three years; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Covenant Health Advantage (HMO) plan covers vision services, including routine eye exams with a $40 copay. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum benefit of $125 per year. Upgrades are not covered.
Dental Services See details
Covenant Health Advantage (HMO) offers dental services with a $2,500 annual maximum. Oral exams and cleanings are covered, and dental x-rays are covered, with a limit on the number of visits and periodicity. Restorative services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery are covered with 50% coinsurance, while fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Covenant Health Advantage (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Covenant Health Advantage (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. For Durable Medical Equipment, there is a 20% coinsurance, and for Prosthetic Devices and Medical Supplies, there is also a 20% coinsurance; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Covenant Health Advantage (HMO) plan. Diagnostic Radiological Services have a copay of at most $325, and Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Covenant Health Advantage (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Covenant Health Advantage (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items with a maximum benefit of $30 every three months, while acupuncture, meal benefits, 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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