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 (TTY 711). 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 (Vantage) is an HMO with a Medicare contract. Enrollment in Vantage depends on contract renewal.

This information is not a complete description of benefits. Call 1-888-823-1910 (TTY users call 711) for more information.