West Texas Counties We CoverSee North Texas countiesSee Central Texas counties
Medicare Advantage eligibility is based on your county of residence. We offer one or more Medicare Advantage plans in the following West Texas counties:
Crosby
Floyd
Garza
Hale
Hockley
Lubbock
Lynn
Terry
Covenant Health Advantage HMO | $0 with Rx | $0 without Rx* + –
Monthly premium
- HMO with Rx (with Part D prescription drug coverage): $0
- HMO without Rx (without Part D prescription drug coverage): $0*
- HMO without Rx pays $50 per month toward your Part B premium
Prescription drug benefits (HMO with Rx)
- Initial coverage amount: $4,660
- Deductible: $0
- HMO plans may be purchased with or without Part D prescription drug coverage
Annual deductible: $0
Out-of-pocket maximum
- HMO with Rx: $6,000
- HMO without Rx: $5,900*
Primary care physician office visit: $0 copay
Specialist office visit: $25 copay
Outpatient surgery: $325 copay
Emergency care (within the U.S.; copay waived if admitted within 24 hours): $90 copay
Urgent care (within the U.S.; copay waived if admitted within 24 hours): $50 copay
Ambulance (within the U.S.)
- HMO with Rx: $300 copay
- HMO without Rx: $265 copay*
Worldwide emergency and urgent care services (outside the U.S.): $0 copay, $5,000 maximum
Telehealth visits (PCP, SCP, Psychiatry Services): $0 copay
Physical/Occupational/Speech Therapy: $35 copay (per visit)
Routine transportation (up to 24 one-way trips per year, or 12 round trips up to 50 miles each way)
In-home meal benefits (14 meals per hospital discharge, up to 3 discharges per year)
Hearing aids (allowance toward purchase every 3 years): $1,000
Dental, vision, hearing, and fitness benefits included
Over-the-Counter (OTC) allowance (must use OTC network card at participating retailers; no rollover)
- HMO with Rx: $50 quarterly allowance
- HMO without Rx: $30 quarterly allowance*