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HealthTeam Advantage Plan I (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthTeam Advantage Plan I (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthTeam Advantage Plan I (PPO) in 2025, please refer to our full plan details page.
HealthTeam Advantage Plan I (PPO) is a PPO plan offered by HTA Holdings, LLC available for enrollment in 2025 to people living in Greater Piedmont Triad Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that HealthTeam Advantage Plan I (PPO) 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 Plan I (PPO).
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 Plan I (PPO), 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 combined Maximum Out-Of-Pocket cost of $5950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 HealthTeam Advantage Plan I (PPO)
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Drug Coverage
The HealthTeam Advantage Plan I (PPO) has an "Enhanced Alternative" drug benefit. This plan has no deductible. In the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $5.00 at a preferred pharmacy, and $20.00 at a standard pharmacy. For non-preferred drugs, you will pay 33% coinsurance. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for your covered drugs.
Additional Benefits
The HealthTeam Advantage Plan I (PPO) offers a wide variety of benefits with varying cost-sharing. Inpatient hospital stays have a copay, and outpatient services include copays for hospital services and substance abuse. Emergency, primary care, preventive, and home health services have no copay, while vision and hearing services have copays for exams. The plan also covers dental services, home infusion, and dialysis with coinsurance, as well as durable medical equipment and diagnostic services with copays and coinsurance. Additional benefits include coverage for hearing aids, eyewear, and over-the-counter items. This plan has many benefits, but it is important to understand the copays, coinsurance, and prior authorization requirements for specific services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with a copay of $325 for days 1-6 and no copay for days 7-90, and Inpatient Hospital Psychiatric with a copay of $315 for days 1-8 and no copay for days 9-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay for Inpatient Hospital-Acute and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a $325 copay, observation services, ambulatory surgical center services with a $225 copay, and outpatient substance abuse services with a $20 copay for individual and group sessions. Outpatient blood services are covered with 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the HealthTeam Advantage Plan I (PPO) with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HealthTeam Advantage Plan I (PPO). Ground ambulance services have a $250 copay, while air ambulance services have a $350 copay, and all ambulance services have 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 under the HealthTeam Advantage Plan I (PPO). Emergency Services have a $140 copay, and Urgently Needed Services have a $25 copay; both have no coinsurance, while Worldwide Emergency Services has a maximum plan benefit coverage of $75,000.
Primary Care See details
The HealthTeam Advantage Plan I (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $15 copay. Physician specialist services and other health care professional services have a $20 copay, and physical therapy and speech-language pathology services have a $15 copay. Mental health and psychiatric services have a $20 copay for individual and group sessions. Additional telehealth benefits have a copay between $0 and $20, and opioid treatment program services have a $20 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The HealthTeam Advantage Plan I (PPO) covers preventive services, including annual physical exams, and other preventive services. Some additional preventive services, such as health education, in-home safety assessments, and counseling services, are not covered.
Hearing Services See details
The HealthTeam Advantage Plan I (PPO) offers Hearing Services, including hearing exams with a $20 copay. Prescription hearing aids are covered, with a copay between $299 and $799 for all types of hearing aids. OTC hearing aids are not covered, nor are prescription hearing aids for the inner ear, outer ear, or over the ear.
Vision Services See details
Vision services include coverage for eye exams with a $20 copay, and routine eye exams with a $25 copay. Eyewear is covered up to a combined maximum of $125 per year for both in-network and out-of-network services, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The HealthTeam Advantage Plan I (PPO) covers dental services, including oral exams with a $20 copay, dental x-rays with 0%-20% coinsurance, and other diagnostic services with 0%-20% coinsurance. Fluoride treatments and orthodontics are not covered, but orthodontics has a maximum benefit of $2500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HealthTeam Advantage Plan I (PPO) with prior authorization required. You will pay 20% coinsurance for these services.
Medical Equipment See details
The HealthTeam Advantage Plan I (PPO) covers durable medical equipment (DME) with a 25% coinsurance and requires prior authorization, while durable medical equipment for use outside the home is not covered. Prosthetics, medical supplies, and diabetic supplies are covered with a 25% coinsurance, but there is no coinsurance for diabetic supplies, and diabetic therapeutic shoes/inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests and Lab Services, are covered with a copay of $10 to $100. Diagnostic Radiological Services have a copay of up to $300, while Therapeutic Radiological Services have a coinsurance of 20% or more. Outpatient X-Ray Services have a copay of $10.
Home Health Services See details
Home Health Services are covered by the HealthTeam Advantage Plan I (PPO) with no copay or coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HealthTeam Advantage Plan I (PPO). A doctor referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HealthTeam Advantage Plan I (PPO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items, with a maximum benefit of $70 every three months, as well as meal benefits for chronic illness or medical conditions that require the enrollee to remain at home. 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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