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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 2026, please refer to our full plan details page.
HealthTeam Advantage Vitality Plan (PPO) is a PPO plan offered by Risant Health, Inc. available for enrollment in 2025 to people living in Piedmont-Coastal Plains area. This plan received an overall rating of 4 out of 5 stars in 2026.
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.
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 $300.00 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 Vitality Plan (PPO) has a drug deductible of $300. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or standard mail order, while standard pharmacies charge a $10 copay for a one-month supply. For Tier 2 generic drugs, copays are as low as $3 for a one-month supply at preferred pharmacies and standard mail order, compared to $17 at standard pharmacies. Tier 3 preferred brand drugs require a 20% coinsurance at preferred pharmacies and standard mail order, which increases to 25% at standard pharmacies. Tier 4 non-preferred drugs carry a 35% coinsurance at preferred pharmacies and standard mail order, while Tier 5 specialty drugs require a 29% coinsurance across all pharmacy options for a one-month supply.
Additional Benefits
The HealthTeam Advantage Vitality Plan (PPO) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive care, and home health services. For inpatient hospital stays, members pay a daily copay of $335 for days one through six and no copay for subsequent days, while specialist visits require a $35 copay with no coinsurance. Emergency room services are covered with a $150 copay, and urgent care visits carry a $50 copay, both with no coinsurance. Routine dental, vision, and hearing services are partially covered, featuring manageable copays and no coinsurance, including up to $150 annually for eyewear with no copay and up to $60 every three months for over-the-counter items. Diagnostic lab services and home infusion also feature no copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Skilled nursing facility stays are covered with no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
HealthTeam Advantage Vitality Plan (PPO) covers inpatient acute hospital stays with no coinsurance and a $335 daily copay for days 1 through 6, and no copay for days 7 and beyond. Inpatient psychiatric stays are also covered with no coinsurance and a $300 daily copay for days 1 through 8, and no copay for days 9 through 90, though prior authorization is required and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the HealthTeam Advantage Vitality Plan (PPO) cover outpatient hospital visits with a $350 copay and no coinsurance, and ambulatory surgical center services with a $225 copay and no coinsurance. Additionally, outpatient substance abuse sessions require a $35 copay and no coinsurance, while outpatient blood services feature no copay and a 20% coinsurance.
Partial Hospitalization See details
HealthTeam Advantage Vitality Plan (PPO) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HealthTeam Advantage Vitality Plan (PPO) partially covers Ambulance and Transportation Services, as transportation to plan-approved or any health-related locations is not covered. Covered ground ambulance services require a $300 copay and air ambulance services require a $500 copay, with no coinsurance and prior authorization required for both.
Emergency Services See details
HealthTeam Advantage Vitality Plan (PPO) covers emergency services with a $150 copay (waived if admitted to the hospital within 3 days) and no coinsurance, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 lifetime maximum with no copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
HealthTeam Advantage Vitality Plan (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits, occupational therapy, and mental health services with a $35 copay and no coinsurance. Chiropractic care is partially covered with a $20 copay and no coinsurance, excluding other chiropractic services, while physical therapy ranges from a $15 to $35 copay with no coinsurance.
Preventive Services See details
HealthTeam Advantage Vitality Plan (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. However, additional preventive services are only partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by the HealthTeam Advantage Vitality Plan (PPO), which offers routine hearing exams and fitting evaluations for a $25 to $35 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a $299 to $799 copay and no coinsurance, though over-the-counter hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by the HealthTeam Advantage Vitality Plan (PPO), which excludes other eye exam services but covers routine exams with a $25 copay (or $35 copay for other covered exams) and no coinsurance. Eyewear is covered with no copay and no coinsurance up to a $150 annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by the HealthTeam Advantage Vitality Plan (PPO), requiring a $35.00 copay and no coinsurance for Medicare-covered dental, and a $20.00 copay with no coinsurance for other covered services. While oral exams, cleanings, and x-rays are covered, fluoride treatment, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
HealthTeam Advantage Vitality Plan (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance and no copay.
Dialysis Services See details
HealthTeam Advantage Vitality Plan (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is partially covered by the HealthTeam Advantage Vitality Plan (PPO) with no copays, though prior authorization is required. A 20% coinsurance applies to durable medical equipment, prosthetic devices, and medical supplies, while diabetic supplies range from no coinsurance to 20% coinsurance, and diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the HealthTeam Advantage Vitality Plan (PPO), with prior authorization required. Members pay no copay and no coinsurance for lab services, while diagnostic tests have a copay of $0 to $100 with no coinsurance. Outpatient X-rays require a $10 copay with coinsurance, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the HealthTeam Advantage Vitality Plan (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services under the HealthTeam Advantage Vitality Plan (PPO) require a referral and have no coinsurance, but only some services are covered. Standard cardiac, intensive cardiac, and pulmonary rehabilitation services are not covered and carry a $35 copay, while SET for PAD services are not covered and carry a $30 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HealthTeam Advantage Vitality Plan (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
HealthTeam Advantage Vitality Plan (PPO) partially covers other services, providing up to $60 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and nicotine replacement therapy are not covered.
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