A non-government entity
Covenant Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Covenant Advantage (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Covenant Advantage (HMO-POS) in 2025, please refer to our full plan details page.
Covenant Advantage (HMO-POS) is a HMO-POS plan offered by University of Michigan Health available for enrollment in 2025 to people living in Bay, Huron, Saginaw, Sanilac, Tuscola counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Covenant Advantage (HMO-POS) 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 Covenant Advantage (HMO-POS).
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 Advantage (HMO-POS), 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 $5000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $3900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5000.00 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 Advantage (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Covenant Advantage (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions, which varies based on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies and a $20 copay at standard pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. However, if you qualify for the low-income subsidy, you may be eligible for a reduced premium.
Additional Benefits
The Covenant Advantage (HMO-POS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $175 copay for the first seven days, with no copay afterward. Outpatient services and emergency services have copays, and ambulance services have a $200 copay. The plan covers primary care with copays ranging from $20-$35, preventive services, and offers hearing and vision benefits with copays and coverage limits. Dental services, home infusion, dialysis services, medical equipment, and diagnostic services are covered with copays or coinsurance. Additionally, the plan offers home health services with no copay, covers skilled nursing facility stays, and includes an over-the-counter benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which have a $175 copay for days 1-7, and no copay for days 8-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services under Covenant Advantage (HMO-POS) covers outpatient hospital services and observation services with a $150 copay. Ambulatory Surgical Center (ASC) Services have a $100 copay. Individual sessions for outpatient substance abuse have a $30 copay, and group sessions have a $25 copay. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Covenant Advantage (HMO-POS) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $200 copay, and transportation services to a plan-approved health-related location are covered for 20 one-way taxi trips per year.
Emergency Services See details
Emergency services, urgently needed services, and worldwide emergency coverage are covered by the Covenant Advantage (HMO-POS) plan. Emergency services and worldwide emergency coverage have a $140 copay, while urgently needed services have a $60 copay, and all have no coinsurance; worldwide emergency transportation is not covered.
Primary Care See details
The Covenant Advantage (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $35 copay, mental health specialty services with a $25-$30 copay, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a $0-$35 copay, and opioid treatment program services with a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, annual physical exams, and other preventive services. Fitness Benefits, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit are also covered. Some services are not covered, including Health Education, In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, and others.
Hearing Services See details
Hearing Services includes hearing exams with a $25 copay, and the fitting/evaluation for a hearing aid is covered. Prescription hearing aids (all types) are covered with a maximum plan benefit of $1,000 every two years, but 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 Advantage (HMO-POS) plan covers vision services, including eye exams with a $35 copay, and offers routine eye exams and other eye exam services once per year. Eyewear is covered with a combined maximum benefit of $200 every year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including a $35 copay for Medicare Dental Services and coverage for Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery. However, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Covenant Advantage (HMO-POS) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance that ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance that ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Covenant Advantage (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Covenant Advantage (HMO-POS) plan covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $100, Therapeutic Radiological Services have a copay of at least $25, and Outpatient X-Ray Services have a copay of $35.
Home Health Services See details
Home Health Services are covered by Covenant Advantage (HMO-POS) with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Covenant Advantage (HMO-POS) plan, but the specific services covered are not listed. The plan has a copay for the services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Covenant Advantage (HMO-POS), but require prior authorization. There is no copay for days 1-20, and a $150 copay for days 21-100.
Other Services See details
The Covenant Advantage (HMO-POS) plan covers over-the-counter items with a maximum benefit of $85 every three months, including nicotine replacement therapy and Naloxone coverage. Acupuncture, meal benefits, and several other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved