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Covenant Advantage Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Covenant Advantage Plus (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 Plus (HMO-POS) in 2025, please refer to our full plan details page.
Covenant Advantage Plus (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 Plus (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 Plus (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 Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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:
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Drug Coverage
The Covenant Advantage Plus (HMO-POS) plan has an "Enhanced Alternative" drug benefit. This plan has no deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions, depending on the drug tier and pharmacy. For example, a preferred generic drug has a $10 copay at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Covenant Advantage Plus (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $175 copay for days 1-7 and no copay for days 8-90, while outpatient services, including mental health and substance abuse services, have copays ranging from $25 to $150. This plan also covers services such as ambulance, emergency care, primary care, hearing, vision, and dental, each with specific copays. Additionally, it includes coverage for home health, skilled nursing facilities, and home infusion services, along with an allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits cover acute and psychiatric inpatient hospital stays, including services not usually covered by Medicare, with a $175 copay for days 1-7 and no copay for days 8-90. Additional days for both acute and psychiatric stays are covered with no copay, while non-Medicare-covered stays and upgrades for acute and psychiatric stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $150 copay, observation services with a $150 copay, and ambulatory surgical center services with a $100 copay. Outpatient substance abuse services are covered with a $30 copay for individual sessions and a $25 copay for group sessions, and outpatient blood services are covered with a waived three (3) pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Covenant Advantage Plus (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for both ground and air ambulance services, each with a $200 copay. Transportation services to a plan-approved health-related location are covered for up to 30 one-way taxi trips per year, while transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by Covenant Advantage Plus (HMO-POS). Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services have a $60 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Covenant Advantage Plus (HMO-POS) covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, and physician specialist services with a $30 copay. Mental health services have a $30 copay for individual sessions and a $25 copay for group sessions. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a copay between $0 and $30, and opioid treatment program services have a $30 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Covenant Advantage Plus (HMO-POS) plan covers preventive services, including annual physical exams, glaucoma screenings, and diabetes self-management training. However, health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, and fitting/evaluation for hearing aids, and prescription hearing aids (all types) with a maximum plan benefit of $1500 every two years. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Covenant Advantage Plus (HMO-POS) plan covers vision services, including eye exams with a $30 copay, and other eye exam services with a $39 copay. Eyewear is covered with a combined maximum of $400 per year, and you are limited to one pair of contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames per year. Upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams with a $30 copay, dental X-rays, prophylaxis (cleaning), and fluoride treatment. Other services, such as restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, are covered with a coinsurance between 0% and 50%, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Covenant Advantage Plus (HMO-POS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment with 20% coinsurance and Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts, each with 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a maximum copay of $10, while Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $100, Therapeutic Radiological Services have a copay of $25, and Outpatient X-Ray Services have a copay of $35.
Home Health Services See details
Home Health Services are covered by Covenant Advantage Plus (HMO-POS) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Covenant Advantage Plus (HMO-POS) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Covenant Advantage Plus (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $150.
Other Services See details
Other Services include coverage for over-the-counter items up to $120 every three months, and nicotine replacement therapy; acupuncture, meal benefits, and several other services are not covered. The plan does not require authorization or a referral for additional services.
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