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What does Passport Advantage (HMO SNP) Cover? - 2011

Passport Advantage covers all of the following through one plan:

Hospital Stays (Medicare Part A)
Doctor Visits (Medicare Part B)
Prescription Drugs (Medicare Part D)

Extra Coverage as a Passport Health Plan member

As a Passport Advantage member, you continue to get Medicaid benefits from Passport Health Plan! This includes:

Vision,
Dental, and
Some prescription drugs not covered by Medicare.

To see how Passport Advantage and Passport Health Plan work together, see our Benefits Chart.

These important papers tell you about the benefits and rules of Passport Advantage:

2011 Summary of Benefits H1807_001_PA10173_CMS Approved_09/22/2010 (PDF)
Download a booklet that tells you about 2011 Passport Advantage benefits

2011 Evidence of Coverage H1807_001_PA10172_CMS Approved_10/21/2011 (PDF)
Download a book that explains all of Passport Advantage's rules and benefits for 2011

Passport Advantage is a health plan with a Medicare contract. This Plan is available to all anyone who is an active Passport Health Plan members and who has Medicare Parts A and B. Eligible beneficiaries may enroll in the plan at any time. Please call Passport Advantage for more information. Benefits, formulary, pharmacy, network, premium, and/or co-payments may change on January 1, 2012. Copays may vary based on the level of Extra Help you receive. Contact Passport Advantage for more details. Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances. Quantity limitations and restrictions may apply. The content on this website is available in alternate formats, such as Braille, large type, or another language. Please call us at 1-800-578-0603, then press 1 TTY: 1-800-648-6056, 7 days a week from 8 a.m. to 8 p.m. to request another format.
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