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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 2025, please refer to our full plan details page.
HealthTeam Advantage Plan II (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 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 $44.00. 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:
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Drug Coverage
The HealthTeam Advantage Plan II (PPO) has an "Enhanced Alternative" drug benefit. This plan has a $0 deductible. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at preferred pharmacies, and $12 at standard pharmacies. For standard generic drugs, the copay is $47.00. For preferred brand drugs, the copay is $100.00. Non-preferred drugs have a 33% coinsurance.
Additional Benefits
The HealthTeam Advantage Plan II (PPO) offers a range of healthcare benefits. The plan covers inpatient hospital stays with a $250 copay, and outpatient services with varying copays and coinsurance. Emergency services, primary care, preventive services, and home health services are covered, with some services having no copay. The plan also includes vision and hearing services, dental services, and coverage for medical equipment. Additional benefits include coverage for diagnostic and radiological services, dialysis services, and other services like acupuncture and over-the-counter items. Certain services, such as cardiac rehabilitation and additional hours of home health care, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $250 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $250 copay for days 1-8, and no copay for days 9-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $325 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay between $15 and $15, and Outpatient Blood Services with 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the HealthTeam Advantage Plan II (PPO) with a $30 copay, and prior authorization is required.
Ambulance and Transportation Services See details
The HealthTeam Advantage Plan II (PPO) covers ambulance services with no coinsurance; however, there is a $200 copay for ground ambulance services and a $300 copay for air ambulance services. 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 II (PPO). Emergency Services have a $130 copay, and Urgently Needed Services have a $20 copay, with no coinsurance for either. Worldwide Emergency Transportation is not covered.
Primary Care See details
The HealthTeam Advantage Plan II (PPO) covers primary care physician services, chiropractic services (with a $10 copay), occupational therapy (with a $15 copay), physician specialist services (with a $15 copay), mental health specialty services (with a $15 copay for individual and group sessions), other health care professional services (with a $15 copay), psychiatric services (with a $15 copay for individual and group sessions), physical therapy and speech-language pathology services (with a $15 copay), additional telehealth benefits (with a $0-$15 copay), and opioid treatment program services (with a $15 copay); however, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered services, an annual physical exam, and additional preventive services. The plan also covers Home-Based Palliative Care, In-Home Support Services, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Some preventive services, such as Health Education, In-Home Safety Assessment, and Counseling Services, are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $15 copay and Routine Hearing Exams with a copay of $25. Prescription Hearing Aids (all types) are covered with a copay between $299 and $799, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
The HealthTeam Advantage Plan II (PPO) covers vision services, including eye exams with a $15 copay, and routine eye exams with a $25 copay. Eyewear has a combined maximum benefit of $150 every year, and the plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The HealthTeam Advantage Plan II (PPO) offers dental services, including Medicare dental services with a $15 copay, and other dental services like oral exams with no copay, and dental x-rays and other diagnostic services with 0-20% coinsurance. This plan does not cover fluoride treatments or orthodontics, and has a yearly maximum of $3,000 for orthodontic services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HealthTeam Advantage Plan II (PPO), but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment with a 20% coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts, with no copay. Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures/tests have a copay between $5.00 and $75.00, lab services have a $5.00 copay, diagnostic radiological services have a copay up to $275.00, therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have a $10.00 copay.
Home Health Services See details
Home Health Services are covered by the HealthTeam Advantage Plan II (PPO) with no copay or coinsurance; however, 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 II (PPO). A doctor's referral is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HealthTeam Advantage Plan II (PPO) with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the HealthTeam Advantage Plan II (PPO), Other Services includes acupuncture with a $15 copay, and Over-the-Counter (OTC) items up to $60 every three months. The plan also offers a meal benefit for chronic illnesses or medical conditions requiring the enrollee to remain at home for a period of time. However, services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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