COVENTRY HEALTH CARE OF ILLINOIS, INC.

What the CMS Data Shows About COVENTRY HEALTH CARE OF ILLINOIS, INC.

COVENTRY HEALTH CARE OF ILLINOIS, INC. operates under CMS contract H1206, issued by Aetna Medicare (parent organization CVS Health Corporation). The contract is classified as a HMO POS product, which governs how enrollees access care: the product rules govern provider access and cost-sharing for this contract. This contract is also flagged in CMS data as a Special Needs Plan (SNP), meaning enrollment is restricted to beneficiaries meeting specific eligibility criteria — chronic condition, dual Medicare-Medicaid status, or institutional residence. Service area spans 48 states (AL, AR, AZ, CA, CO, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY) and more than 40 counties, a geography set at the CMS service-area definition level.

The overall CMS Star Rating for this contract is not yet published by CMS. This rating synthesizes 13 individual quality measures spanning 5 CMS domains, including clinical outcomes, patient experience (CAHPS), member complaints and appeals, and plan operations. The Part D drug-benefit portion of this contract carries a separate CMS Star Rating of 3.0, which reflects pharmacy cost, adherence to chronic medications, and drug pricing accuracy. Ratings at 4+ stars trigger federal Quality Bonus Payments that insurers typically reinvest in supplemental benefits.

On costs, this contract lists a monthly plan premium of not reported. Beyond standard Medicare Parts A and B, the contract documents 21 supplemental benefits in the CMS benefits file — coverage extras such as dental, vision, hearing aids, fitness programs, and OTC allowances that Original Medicare does not provide. Before enrolling, verify that your preferred providers participate in the plan's network for your specific county, review the current Summary of Benefits, and confirm that your prescriptions appear on the plan formulary. All figures shown come from CMS public-use files for the 2026 contract year; this page is informational only and is not personalized Medicare counseling advice.