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HealthTeam Advantage Plan II (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthTeam Advantage Plan II (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 II (PPO) in 2026, please refer to our full plan details page.
HealthTeam Advantage Plan II (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 II (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 II (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 II (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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 $150.00 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 II (PPO) features a $150 drug deductible and offers excellent savings on generic medications. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or standard mail order for any supply length. If you choose a standard pharmacy, Tier 1 copays range from $5 to $15, while Tier 2 copays range from $15 to $45 depending on the supply fill. For brand-name and specialty drugs under this plan, your costs are determined by coinsurance percentages during the initial coverage phase. Tier 3 preferred brands require a 20% coinsurance at preferred pharmacies and standard mail order, rising to 25% at standard pharmacies. Tier 4 non-preferred drugs carry a 35% to 45% coinsurance, while Tier 5 specialty drugs require a flat 31% coinsurance across all pharmacy options for a one-month supply.
Additional Benefits
The HealthTeam Advantage Plan II (PPO) offers comprehensive medical coverage with no deductibles and affordable cost-sharing for essential services. You will pay no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits and Medicare-covered dental services, there is a low $20 copay with no coinsurance, while urgent care visits require a $30 copay and emergency room visits require a $130 copay. Inpatient hospital stays require a $275 daily copay for days 1 to 5, after which there is no copay, while skilled nursing facility care features no copay for the first 20 days. Additionally, the plan provides valuable ancillary benefits, including preventive dental cleanings with no copay, as well as a $60 quarterly allowance for over-the-counter items. Most other services, such as durable medical equipment and dialysis, require a standard 20% coinsurance with no copay.
Inpatient Hospital See details
HealthTeam Advantage Plan II (PPO) covers inpatient hospital services with no coinsurance, requiring a $275 daily copay for days 1 to 5 of acute stays (with no copay for days 6 to 90 and unlimited additional days) and a $275 daily copay for days 1 to 8 of psychiatric stays (with no copay for days 9 to 90). This benefit is partially covered as upgrades and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
Outpatient services are covered by HealthTeam Advantage Plan II (PPO), featuring a $325 copay and no coinsurance for outpatient hospital services, and a $200 copay with no coinsurance for ambulatory surgical center services. Outpatient substance abuse services require a $20 copay with no coinsurance, while outpatient blood services have no copay and 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by the HealthTeam Advantage Plan II (PPO) with a $30.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HealthTeam Advantage Plan II (PPO) covers ambulance services with no coinsurance, requiring a $200 copay for ground transport and a $300 copay for air transport, both of which require prior authorization. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
HealthTeam Advantage Plan II (PPO) covers emergency services with a $130 copay (waived if admitted within three days) and no coinsurance, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency and urgent services are partially covered with no copay or coinsurance up to a $75,000 lifetime limit, though worldwide emergency transportation is not covered.
Primary Care See details
HealthTeam Advantage Plan II (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapies, and mental health services require a $20 copay and no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance, excluding routine and other chiropractic services, while podiatry services are not covered.
Preventive Services See details
HealthTeam Advantage Plan II (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams and kidney disease education. Additional preventive services are partially covered with no copay and no coinsurance, but do not include health education, weight management, alternative therapies, in-home safety assessments, or personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by the HealthTeam Advantage Plan II (PPO), offering hearing exams with a $20 to $25 copay and no coinsurance. Prescription hearing aids are covered with a copay of $299 to $799 and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
HealthTeam Advantage Plan II (PPO) covers vision services with no deductibles, featuring eye exams with a $20 copay ($25 for routine exams) and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance, providing up to a $125 annual combined maximum for contacts, frames, or lenses.
Dental Services See details
Dental services are partially covered by the HealthTeam Advantage Plan II (PPO), which features a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive exams, cleanings, and X-rays. Comprehensive services are covered with no copay and 0% to 50% coinsurance up to a $2,000 annual limit, though fluoride treatment, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthTeam Advantage Plan II (PPO) with no copay, though prior authorization and step therapy are required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the HealthTeam Advantage Plan II (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthTeam Advantage Plan II (PPO) partially covers medical equipment with no copay, though diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment, prosthetics, and medical supplies require a 20% coinsurance, while diabetic supplies have coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
HealthTeam Advantage Plan II (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures and lab services require a $5 to $75 copay with no coinsurance, while diagnostic radiological services have no copay, outpatient X-rays have a $10 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
HealthTeam Advantage Plan II (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by the HealthTeam Advantage Plan II (PPO) with a referral and no coinsurance, meaning some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a $20 copayment.
Skilled Nursing Facility (SNF) See details
HealthTeam Advantage Plan II (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond the standard Medicare-covered limit are not covered. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, and no prior three-day inpatient hospital stay is required.
Other Services See details
HealthTeam Advantage Plan II (PPO) covers acupuncture with a $20 copay and no coinsurance for up to 30 treatments per year, alongside meal benefits for chronic illnesses and over-the-counter items up to $60 quarterly with no copay and no coinsurance. Certain other supplemental services, including nicotine replacement therapy, naloxone, and dual-eligible SNP benefits, are not covered.
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