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HealthTeam Advantage Vitality Plan (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthTeam Advantage Vitality 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 Vitality Plan (PPO) in 2025, please refer to our full plan details page.
HealthTeam Advantage Vitality 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 Vitality Plan (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 Vitality 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 Vitality 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. Additionally, this plan comes with a Part B Premium reduction of $3.00. You must continue to pay paying your reduced 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 $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:
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Drug Coverage
The HealthTeam Advantage Vitality Plan (PPO) has an enhanced alternative drug benefit. The plan has a $150 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $5 copay for preferred generic drugs at a preferred pharmacy and 40% coinsurance for preferred brand drugs at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HealthTeam Advantage Vitality Plan (PPO) offers a range of benefits, including inpatient hospital stays with copays ranging from $0-$335, outpatient services with copays from $30-$300, and various specialist and primary care visits with $10-$30 copays. Emergency services have a $140 copay, while hearing and vision services include copays for exams and eyewear. This plan also covers dental services with copays, home health services with no copay, and offers coverage for medical equipment with coinsurance. Additionally, there is a $60 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you'll pay a $335 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, the copay is $300 for days 1-8, and no copay for days 9-90. Additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $300 copay, Ambulatory Surgical Center (ASC) services with a $200 copay, and outpatient substance abuse services with a $30 copay per session. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the HealthTeam Advantage Vitality Plan (PPO), with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HealthTeam Advantage Vitality Plan (PPO). Ground Ambulance Services have a $300 copay, and Air Ambulance Services have a $350 copay, with no coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HealthTeam Advantage Vitality Plan (PPO). Emergency Services have a $140 copay and no coinsurance, while Urgently Needed Services have a $35 copay and no coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $100,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The HealthTeam Advantage Vitality Plan (PPO) offers coverage for primary care services, chiropractic services with a $10 copay, occupational therapy services with a $30 copay, physician specialist services with a $30 copay, mental health specialty services with a $30 copay, podiatry services with a $30 copay, other health care professional services with a $30 copay, psychiatric services with a $30 copay, physical therapy and speech-language pathology services with a $10-$30 copay, additional telehealth benefits with a $0-$30 copay, and opioid treatment program services with a $30 copay.
Preventive Services See details
The HealthTeam Advantage Vitality Plan (PPO) covers preventive services, including Medicare-covered services with no copay, annual physical exams, and additional preventive services that require prior authorization. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, nutritional/dietary benefits, in-home support 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.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, and routine hearing exams are covered with a $25 copay per visit. Prescription hearing aids are covered with a copay between $299 and $799, while 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 Vitality Plan (PPO) covers vision services, including eye exams with a $30 copay. Routine eye exams have a $25 copay, and eyewear is covered with a combined maximum of $150 every year, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, oral exams and dental x-rays with a $20 copay, prophylaxis (cleaning) with a $20 copay, and other diagnostic services with a $20 copay. Fluoride treatments, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
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, while 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 Vitality Plan (PPO), but require prior authorization. The plan has a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance with no copay, while Prosthetics/Medical Supplies have a 20% coinsurance and no copay, and Diabetic Supplies have a 0-20% coinsurance 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
The HealthTeam Advantage Vitality Plan (PPO) covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $100, and lab services with no copay. Therapeutic Radiological Services have a coinsurance of at least 20%, and outpatient X-ray services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the HealthTeam Advantage Vitality Plan (PPO) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthTeam Advantage Vitality Plan (PPO). This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HealthTeam Advantage Vitality Plan (PPO) with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services benefits are partially covered under the HealthTeam Advantage Vitality Plan (PPO). Acupuncture, Meal Benefit, 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. Over-the-counter (OTC) items are covered with a maximum plan benefit of $60.00 every three months.
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