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HealthTeam Advantage Eagle Plan (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthTeam Advantage Eagle Plan (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthTeam Advantage Eagle Plan (PPO) in 2025, please refer to our full plan details page.
HealthTeam Advantage Eagle Plan (PPO) is a PPO plan offered by HTA Holdings, LLC available for enrollment in 2025 to people living in Piedmont-Coastal Plains area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that HealthTeam Advantage Eagle Plan (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HealthTeam Advantage Eagle Plan (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 Eagle Plan (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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6200.00 (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 $6200.00 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 Eagle Plan (PPO)
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Drug Coverage
Prescription drugs are not covered by HealthTeam Advantage Eagle Plan (PPO).
Additional Benefits
The HealthTeam Advantage Eagle Plan (PPO) offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. The plan also covers primary care, preventive services, hearing, vision, and dental, each with specific copays and maximum benefits. Other benefits include ambulance, emergency, and home health services with no copays, as well as coverage for medical equipment, diagnostic services, and skilled nursing facilities.
Inpatient Hospital See details
The HealthTeam Advantage Eagle Plan (PPO) covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $325 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you'll pay a $300 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $350 copay, observation services, ambulatory surgical center (ASC) services with a $225 copay, outpatient substance abuse services with a copay of $30 for individual sessions and $15 for group sessions, and outpatient blood services with a 20% coinsurance. Outpatient blood services also include three pints with a deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the HealthTeam Advantage Eagle Plan (PPO), with a $50 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, as well as transportation services to a plan-approved health-related location. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are limited to 20 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HealthTeam Advantage Eagle Plan (PPO). Emergency Services have a $125 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Services have a maximum plan benefit coverage of $50,000; all services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The HealthTeam Advantage Eagle Plan (PPO) covers primary care services, including primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $15 copay, physician specialist services with a $30 copay, and mental health specialty services with a $30 copay for individual sessions and a $15 copay for group sessions. The plan also covers other health care professionals with a $30 copay, psychiatric services with a $30 copay for individual sessions and a $15 copay for group sessions, physical therapy and speech-language pathology services with a copay between $15 and $30, additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services with a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The HealthTeam Advantage Eagle Plan (PPO) covers preventive services, including an annual physical exam, with no copay or coinsurance. Additional preventive services are covered, but Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. 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.
Hearing Services See details
Hearing services with the HealthTeam Advantage Eagle Plan (PPO) include routine hearing exams with a $30 copay, fitting/evaluation for hearing aids, and prescription hearing aids (all types) with no copay. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered. There is a maximum plan benefit of $1000 every year for both in-network and out-of-network services.
Vision Services See details
Vision services include coverage for eye exams with a $30 copay, and also covers routine eye exams. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are also covered.
Dental Services See details
The HealthTeam Advantage Eagle Plan (PPO) covers dental services, including oral exams with a $30 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. There is a maximum benefit of $1000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HealthTeam Advantage Eagle Plan (PPO) and require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices and Medical Supplies have a 20% coinsurance; however, 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, including diagnostic procedures and tests, lab services, and outpatient X-ray services, are covered. Diagnostic procedures and tests have a copay between $0 and $100, lab services have a $10 copay, diagnostic radiological services have a copay up to $300, therapeutic radiological services have a 20% coinsurance, and outpatient X-ray services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the HealthTeam Advantage Eagle Plan (PPO) with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the HealthTeam Advantage Eagle Plan (PPO) with a required doctor referral. However, specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HealthTeam Advantage Eagle Plan (PPO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The HealthTeam Advantage Eagle Plan (PPO) covers over-the-counter (OTC) items with a maximum benefit of $75 every three months, and also covers meal benefits for certain chronic or medical conditions. 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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