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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 2026, please refer to our full plan details page.
HealthTeam Advantage Plan I (PPO) is a PPO plan offered by Risant Health, Inc. available for enrollment in 2025 to people living in Greater Piedmont Triad Area. This plan received an overall rating of 4 out of 5 stars in 2026.
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 a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6300.00 (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 $6300.00 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:
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Drug Coverage
The HealthTeam Advantage Plan I (PPO) prescription drug coverage features a $250 annual drug deductible. You can save on costs by using preferred pharmacies or standard mail order, which offer no copay for Tier 1 preferred generic drugs and low $3 copays for Tier 2 generic drugs. Standard pharmacies are also available but come with higher copays, such as $10 for Tier 1 and $15 for Tier 2 monthly supplies. For higher-tier medications, costs transition to coinsurance, with Tier 3 preferred brands requiring 20% coinsurance at preferred pharmacies and 25% at standard pharmacies. Tier 4 non-preferred drugs carry a 35% to 45% coinsurance depending on your pharmacy choice, while Tier 5 specialty drugs require a flat 30% coinsurance for a one-month supply. Choosing preferred network pharmacies or standard mail-order options consistently provides the lowest out-of-pocket costs under this plan.
Additional Benefits
The HealthTeam Advantage Plan I (PPO) offers comprehensive medical coverage with predictable costs, including no copays or coinsurance for primary care visits and preventive services. For inpatient hospital stays, members pay a $325 daily copay for the first few days and no copay for subsequent days, with no coinsurance required. Outpatient hospital services carry a $350 copay, while specialist visits and physical therapy require a $25 copay. This plan also includes valuable supplemental benefits, such as preventive dental care and home health services with no copays or coinsurance. Routine hearing and vision exams require a $25 copay, while select eyewear and over-the-counter items are covered with no copay up to specified plan limits. Additionally, skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay.
Inpatient Hospital See details
HealthTeam Advantage Plan I (PPO) covers inpatient hospital stays with no coinsurance, requiring a daily copay of $325 for days 1 to 6 of acute stays and days 1 to 8 of psychiatric stays, with no copay for subsequent days. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HealthTeam Advantage Plan I (PPO), including outpatient hospital services with a $350 copay and ambulatory surgical center services with a $250 copay, both with no coinsurance. Outpatient substance abuse services require a $25 copay and no coinsurance, while outpatient blood services have no copay and 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the HealthTeam Advantage Plan I (PPO) with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HealthTeam Advantage Plan I (PPO) covers ground ambulance services with a $250 copay and air ambulance services with a $350 copay, with no coinsurance and prior authorization required for both. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
HealthTeam Advantage Plan I (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted to the hospital within three days, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 limit with no copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
HealthTeam Advantage Plan I (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $25 copay and no coinsurance. Chiropractic care is partially covered with a $20 copay and no coinsurance, but routine chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by HealthTeam Advantage Plan I (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive services are partially covered with no copay and no coinsurance (prior authorization required), but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, caregiver support, additional tobacco cessation, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
HealthTeam Advantage Plan I (PPO) hearing services feature a $25 copay and no coinsurance for hearing exams, covering one routine exam yearly and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay between $299 and $799 for up to two devices per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
HealthTeam Advantage Plan I (PPO) offers partially covered vision services, as other eye exam services are not covered. Routine eye exams are available with a $25 copay and no coinsurance, while covered eyewear has no copay and no coinsurance up to a $125 annual maximum limit.
Dental Services See details
Dental services are partially covered by the HealthTeam Advantage Plan I (PPO), featuring preventive care with no copay and no coinsurance, Medicare-covered dental for a $25 copay and no coinsurance, and comprehensive services with no copay and 0% to 50% coinsurance up to a $1,500 annual limit. However, fluoride treatments, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
HealthTeam Advantage Plan I (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HealthTeam Advantage Plan I (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthTeam Advantage Plan I (PPO) partially covers medical equipment with no copays for covered items, though prior authorization is required. Durable medical equipment and prosthetics require a 25% coinsurance, diabetic supplies have no coinsurance to 20% coinsurance, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthTeam Advantage Plan I (PPO) with prior authorization required. Diagnostic services require no coinsurance, with copays of $10 for lab services and $10 to $100 for diagnostic procedures. Radiological services feature a $10 copay for X-rays, no copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the HealthTeam Advantage Plan I (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by HealthTeam Advantage Plan I (PPO) with no coinsurance and a required referral. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice and carry a $25 copay.
Skilled Nursing Facility (SNF) See details
HealthTeam Advantage Plan I (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a daily copay of $218 for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthTeam Advantage Plan I (PPO) partially covers Other Services, which include over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. Eligible OTC items are reimbursed up to $60 every three months, though unused funds do not carry over to the next period.
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