Get help from a licensed insurance agent 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week.
BS

Baylor Scott & White Holdings

Plan ID: H4943-2-0

Covenant Health Advantage (HMO)

2025 Covenant Health Advantage (HMO) H4943002 0 is a Medicare Advantage plan . 0

Learn more about Covenant Health Advantage (HMO) H4943 - 002 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.

0

$0.00 /mo

Monthly premium

$5600.00

Out-of-pocket maximum

Enroll online

Call to enroll

OR

Phone Icon

Get personalized help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week!

Overview Icon

Plan Overview

2025 Covenant Health Advantage (HMO) H4943002 0 is a HMO offered in West Texas by Baylor Scott & White Holdings. It has a monthly premium of $0.00.

Premium Breakdown

Standard Part B Premium

$185.00

Part B premium reduction

- $0

Monthly Plan Premium

$0.00

Total Premium:

$185.00

Note:

The standard Medicare Part B premium for 2025 is $185.00. Your premium may differ based on factors like late enrollment, income (IRMAA), or disability status. Most people enrolled in Medicare Part B are required to pay this premium.

Special needs plan type

No

Out-of-pocket maximum

$5600.00

Plan Organization:

Baylor Scott & White Holdings

Plan Type:

HMO

Location:

West Texas

Drugs Covered:

No

Drug Formulary:

Pharmacies:

Doctor Choice:

Doctors Link:

Deductibles

The amount you must pay each year before your plan starts to pay for covered services or drugs.

Sign up for Covenant Health Advantage (HMO)

Phone Icon

Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week

Drug Coverage Icon

Drug Coverage

Covenant Health Advantage (HMO) does not provide drug coverage. If drug coverage is something you need, you should consider shopping for other plans that do provide cost sharing on drugs.

Dental Icon

Additional Benefits

Covenant Health Advantage (HMO) also provides the following benefits.

Note:

Limits, Authorizations, and Referrals may apply for the benefits below. Contact the plan for details.

Additional Coverage Icon

Comprehensive dental

Endodontics
In-Network: 50 Coins - No Co pay
Limit Icon
Oral and Maxillofacial Surgery
In-Network: 50 Coins - No Co pay
Limit Icon
Periodontics
In-Network: 50 Coins - No Co pay
Limit Icon
Prosthodontics, removable
In-Network: 50 Coins - No Co pay
Limit Icon
Restorative Services
In-Network: 50 Coins - No Co pay
Limit Icon
Additional Coverage Icon

Preventive dental

Dental X-Rays
In-Network: No Coins - No Copay
Limit Icon
Oral Exams
In-Network: No Coins - No Copay
Limit Icon
Other Diagnostic Dental Services
In-Network: No Coins - No Copay
Limit Icon
Prophylaxis (cleaning)
In-Network: No Coins - No Copay
Limit Icon
Additional Coverage Icon

Diagnostic procedures/lab services/imaging

Diagnostic radiology services
Diagnostic tests and procedures
$0 copay
Limit IconExclamation Icon
Lab services
$0 copay
Limit IconExclamation Icon
Outpatient x-rays
$0 copay
Limit IconExclamation Icon
Additional Coverage Icon

Doctor visits

Primary
$0 copay
Limit Icon
Specialist
$30 copay per visit
Limit Icon
Additional Coverage Icon

Emergency care/Urgent care

Urgent care
$50 copay per visit (always covered)
Limit Icon
Emergency
$120 copay per visit (always covered)
Limit Icon
Additional Coverage Icon

Foot care (podiatry services)

Routine foot care
Not covered
Limit Icon
Foot exams and treatment
$40 copay
Limit Icon
Additional Coverage Icon

Ground ambulance

All service types
$265 copay
Limit Icon
Additional Coverage Icon

Hearing

Fitting/evaluation
$0 copay
Limit Icon
Hearing aids
$0 copay
Limit Icon
Hearing aids OTC
Not covered
Limit Icon
Medicare-Covered Hearing Exam
$40 copay
Limit Icon
Additional Coverage Icon

Inpatient hospital coverage

All service types
$325 per day for days 1 through 6 $0 per day for days 7 through 90
Limit IconExclamation Icon
Additional Coverage Icon

Outpatient hospital coverage

All service types
$275 copay or 20% coinsurance per visit
Limit IconExclamation Icon
Additional Coverage Icon

Optional benefits

All service types
No
Limit Icon
Additional Coverage Icon

Medical equipment/supplies

Diabetes supplies
$0 copay
Limit IconExclamation Icon
Durable medical equipment
Prosthetics
Additional Coverage Icon

Medicare Part B drugs

Chemotherapy
0-20% coinsurance
Limit IconExclamation Icon
Other Part B drugs
0-20% coinsurance
Limit IconExclamation Icon
Additional Coverage Icon

Mental health services

Inpatient hospital - psychiatric
$318 per day for days 1 through 5 $0 per day for days 6 through 90
Limit IconExclamation Icon
Outpatient group therapy visit
$30 copay
Limit Icon
Outpatient group therapy visit with a psychiatrist
$30 copay
Limit Icon
Outpatient individual therapy visit with a psychiatrist
$30 copay
Limit Icon
Outpatient individual therapy visit
$30 copay
Limit Icon
Additional Coverage Icon

Preventive care

All service types
$0 copay
Limit Icon
Additional Coverage Icon

Rehabilitation services

Occupational therapy visit
$35 copay
Limit Icon
Physical therapy and speech and language therapy visit
$35 copay
Limit Icon
Additional Coverage Icon

Skilled Nursing Facility

All service types
$0 per day for days 1 through 20 $214 per day for days 21 through 100
Limit IconExclamation Icon
Additional Coverage Icon

Transportation

All service types
Not covered
Limit Icon
Additional Coverage Icon

Vision

Eyeglasses (frames and lenses)
$0 copay
Limit Icon
Upgrades
Not covered
Limit Icon
Eyeglass lenses
$0 copay
Limit Icon
Contact lenses
$0 copay
Limit Icon
Eyeglass frames
$0 copay
Limit Icon
Other
Not covered
Limit Icon
Routine eye exam
$0 copay
Limit Icon
Additional Coverage Icon

Wellness programs (eg, fitness, nursing hotline)

All service types
Not covered
Limit Icon
Overview Icon

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

Contact us phone logo

Get Personalized Help from a licensed insurance agent

1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week

Decorative blobs in the footerMedicareAdvantageRX logo*/

SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M

MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.

This is a promotional communication.

Every year, Medicare evaluates plans based on a 5-star rating system.

Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.

Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period

We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.

Medicare has neither approved nor endorsed any information on this site.

Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week

© 2023 Dog Media Solutions LLC. All rights reserved