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Amerivantage Courage (PPO)

H8343 - 011 - 0
2.5 out of 5 stars (2.5 / 5)

Amerivantage Courage (PPO) is a Medicare Advantage (Part C) Plan by Amerigroup Insurance Company.

This page features plan details for 2023 Amerivantage Courage (PPO) H8343 – 011 – 0 available in Select counties in TN.

IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below:
No 2024 version found. You can use the location links below to find 2024 plans in your area.

Locations

Amerivantage Courage (PPO) is offered in the following locations.

Anderson County, Tennessee
Bedford County, Tennessee
Benton County, Tennessee

Click to see more locations

Plan Overview

Amerivantage Courage (PPO) offers the following coverage and cost-sharing.

Insurer:Amerigroup Insurance Company
Health Plan Deductible:$0.00
MOOP:$10,000 In and Out-of-network
$6,700 In-network
Drugs Covered:No

Ready to sign up for Amerivantage Courage (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Amerivantage Courage (PPO) qualifies for a monthly Medicare Give Back Benefit of $50.00.

Premium Reduction:$50.00

Premium Breakdown

Amerivantage Courage (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$164.90 $0.00 $50.00 $114.90
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Amerivantage Courage (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network: No

Dental (comprehensive)

Diagnostic services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Diagnostic services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Endodontics:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Endodontics:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Extractions:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Extractions:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Non-routine services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Non-routine services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Periodontics:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Periodontics:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Restorative services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Restorative services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)

Dental (preventive)

Cleaning:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Cleaning:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s):In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s):Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Oral exam:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Oral exam:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI):In-Network: $180-275 copay (authorization required) (referral not required)
Diagnostic radiology services (e.g., MRI):Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Diagnostic tests and procedures:In-Network: $0-100 copay (authorization required) (referral not required)
Diagnostic tests and procedures:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Lab services:In-Network: $0-50 copay (authorization required) (referral not required)
Lab services:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Outpatient x-rays:In-Network: $50-110 copay (authorization required) (referral not required)
Outpatient x-rays:Out-of-Network: 30% coinsurance (authorization required) (referral not required)

Doctor visits

Primary:In-Network: $0 copay
Primary:Out-of-Network: 30% coinsurance per visit
Specialist:In-Network: $45 copay per visit (authorization required) (referral not required)
Specialist:Out-of-Network: 30% coinsurance per visit (authorization required) (referral not required)

Emergency care/Urgent care

Emergency: $90 copay per visit (always covered)
Urgent care: $25 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment:In-Network: $0-45 copay (authorization required) (referral not required)
Foot exams and treatment:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Routine foot care:In-Network: $0 copay (no limits) (authorization required) (referral not required)
Routine foot care:Out-of-Network: 30% coinsurance (no limits) (authorization required) (referral not required)

Ground ambulance

In-Network: $290 copay
Out-of-Network: $290 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Fitting/evaluation:Out-of-Network: 20% coinsurance (limits may apply) (authorization required) (referral not required)
Hearing aids:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Hearing aids:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Hearing exam:In-Network: $45 copay (authorization required) (referral not required)
Hearing exam:Out-of-Network: 30% coinsurance (authorization required) (referral not required)

Hospital coverage (inpatient)

In-Network: $295 per day for days 1 through 7
$0 per day for days 8 through 90 (authorization required) (referral not required)
Out-of-Network: 30% per stay (authorization required) (referral not required)

Hospital coverage (outpatient)

In-Network: $0-275 copay per visit (authorization required) (referral not required)
Out-of-Network: 30% coinsurance per visit (authorization required) (referral not required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$10,000 In and Out-of-network
$6,700 In-network

Medical equipment/supplies

Diabetes supplies:In-Network: $0 copay (authorization not required)
Diabetes supplies:Out-of-Network: 30% coinsurance per item (authorization not required)
Durable medical equipment (e.g., wheelchairs, oxygen):In-Network: 0-20% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):Out-of-Network: 30% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):In-Network: 20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):Out-of-Network: 30% coinsurance per item (authorization required)

Medicare Part B drugs

Chemotherapy:In-Network: 20% coinsurance (authorization required)
Chemotherapy:Out-of-Network: 30% coinsurance (authorization required)
Other Part B drugs:In-Network: 20% coinsurance (authorization required)
Other Part B drugs:Out-of-Network: 30% coinsurance (authorization required)

Mental health services

Inpatient hospital – psychiatric:In-Network: $295 per day for days 1 through 6
$0 per day for days 7 through 90 (authorization required) (referral not required)
Inpatient hospital – psychiatric:Out-of-Network: 30% per stay (authorization required) (referral not required)
Outpatient group therapy visit:In-Network: $40 copay (authorization required) (referral not required)
Outpatient group therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist:In-Network: $40 copay (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Outpatient individual therapy visit:In-Network: $40 copay (authorization required) (referral not required)
Outpatient individual therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist:In-Network: $40 copay (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist:Out-of-Network: 30% coinsurance (authorization required) (referral not required)

Optional supplemental benefits

Yes

Preventive care

In-Network: $0 copay (authorization not required) (referral not required)
Out-of-Network: 30% coinsurance (authorization not required) (referral not required)

Rehabilitation services

Occupational therapy visit:In-Network: $40 copay (authorization required) (referral not required)
Occupational therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
Physical therapy and speech and language therapy visit:In-Network: $40 copay (authorization required) (referral not required)
Physical therapy and speech and language therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)

Skilled Nursing Facility

In-Network: $0 per day for days 1 through 20
$196 per day for days 21 through 100 (authorization required) (referral not required)
Out-of-Network: 30% per stay (authorization required) (referral not required)

Transportation

In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)

Vision

Contact lenses:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Contact lenses:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass frames:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass frames:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass lenses:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass lenses:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglasses (frames and lenses):In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglasses (frames and lenses):Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Other: Not covered (no limits)
Routine eye exam:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Routine eye exam:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Upgrades:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Upgrades:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)

Wellness programs (e.g., fitness, nursing hotline)

Covered (authorization not required) (referral not required)

Optional Benefits

Package #1

Preventive dental:Monthly Premium:$5.00
Preventive dental:Deductible:N/A

Package #2

Preventive dental:Monthly Premium:$23.00
Preventive dental:Deductible:N/A
Comprehensive dental:Monthly Premium:$23.00
Comprehensive dental:Deductible:N/A
Eyewear:Monthly Premium:$23.00
Eyewear:Deductible:N/A

Package #3

Preventive dental:Monthly Premium:$42.00
Preventive dental:Deductible:N/A
Comprehensive dental:Monthly Premium:$42.00
Comprehensive dental:Deductible:N/A
Eyewear:Monthly Premium:$42.00
Eyewear:Deductible:N/A

Ready to sign up for Amerivantage Courage (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Table of Contents

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