Vantage Medicare Advantage

Coverage Request Form

Thank you for your interest in Vantage. After completing the form below, we will contact you within the next 1-2 business days. If you prefer to speak with someone instead, please call Toll-Free at (866) 704-0109. If you feel that waiting the standard timeframe for a decision could seriously harm a member’s life, health, or ability to regain maximum function, please ask for an expedited (fast) decision by contacting Vantage by phone or fax.

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Vantage Health Plan, Inc. and Vantage Health Plan of Arkansas, Inc. (Vantage) are HMO's with Medicare contracts. Enrollment in Vantage depends on contract renewal.

Y0143_4006_01_CY2020 Approved 12/7/2019