2015 UnitedHealthcare MedicareDirect Essential (PFFS) H5435-001 By UnitedHealthcare

UnitedHealthcare MedicareDirect Essential (PFFS) By UnitedHealthcare

UnitedHealthcare MedicareDirect Essential (PFFS) is a 2015 Medicare Advantage ("Part C" or "MA Plan") plan by UnitedHealthcare. This plan from UnitedHealthcare works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for UnitedHealthcare MedicareDirect Essential (PFFS) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from UnitedHealthcare and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

2015 Medicare Advantage Plan Details

Plan Name:
UnitedHealthcare MedicareDirect Essential (PFFS)
Plan ID:
Provider: UnitedHealthcare
Plan Year:2015
Plan Type: PFFS *
Monthly Premium C+D: $23.00


Coverage Area for UnitedHealthcare MedicareDirect Essential (PFFS)

(Click county to compare all available plans)

State: Arizona
New Hampshire
North Carolina
Alpine, Calaveras, Colusa,
Del Norte, Humboldt, Mendocino,
Merced, Modoc, Plumas,
Siskiyou, Trinity, Berrien,
Calhoun, Carroll, Chattooga,
Clay, Clinch, Crisp,
Decatur, Fannin, Gilmer,
Grady, Haralson, Heard,
Irwin, Lamar, Lanier,
Macon, Pike, Quitman,
Schley, Sumter, Terrell,
Thomas, Tift, Towns,
Troup, Turner, Union,
Bartholomew, Allen, Anderson,
Chase, Cheyenne, Clay,
Cloud, Decatur, Ellis,
Geary, Graham, Lane,
Logan, Marshall, McPherson,
Nemaha, Neosho, Phillips,
Rawlins, Republic, Riley,
Rooks, Saline, Scott,
Sheridan, Thomas, Washington,
Wilson, Allen, Calloway,
Carter, Christian, Cumberland,
Lyon, Marshall, Monroe,
Trigg, Wayne, Avoyelles,
Adair, Bollinger, Caldwell,
Cape Girardeau, Clark, Daviess,
Grundy, Iron, Knox,
Lewis, Madison, Maries,
Marion, Mercer, New Madrid,
Pike, Putnam, Ralls,
Randolph, Schuyler, Scotland,
Scott, Shannon, Stoddard,
Sullivan, Wayne, Blaine,
Carter, Daniels, Dawson,
Deer Lodge, Fallon, Garfield,
Golden Valley, Liberty, Lincoln,
Madison, Petroleum, Phillips,
Powder River, Prairie, Roosevelt,
Sheridan, Silver Bow, Toole,
Treasure, Valley, Arthur,
Banner, Blaine, Boone,
Box Butte, Buffalo, Cedar,
Cheyenne, Dakota, Dawes,
Dawson, Dixon, Gosper,
Hall, Hamilton, Hooker,
Kearney, Keith, Keya Paha,
Knox, Logan, Loup,
Madison, McPherson, Merrick,
Morrill, Nance, Perkins,
Platte, Scotts Bluff, Sheridan,
Sherman, Stanton, Thomas,
Wheeler, Belknap, Cheshire,
Grafton, Merrimack, Buncombe,
Burke, Yancey, Blaine,
Latimer, Okfuskee, Pontotoc,
Pushmataha, Blanco, Brewster,
Brooks, Brown, Calhoun,
Colorado, Comanche, Crane,
Culberson, DeWitt, Duval,
Eastland, Erath, Frio,
Gillespie, Goliad, Gonzales,
Jack, Jackson, Karnes,
Kerr, La Salle, Lavaca,
Live Oak, Loving, Matagorda,
Maverick, McMullen, Pecos,
Presidio, Reeves, Refugio,
Terrell, Uvalde, Victoria,
Ward, Winkler, Caledonia,
Essex, Franklin, Grand Isle,
Lamoille, Washington, Windham,
Windsor, Augusta, Brunswick,
Carroll, Danville City, Emporia City,
Greensville, Harrisonburg City, Henry,
Martinsville City, Mecklenburg, Patrick,
Rockingham, Spotsylvania, Staunton City,
Waynesboro City, Albany, Crook,
Fremont, Natrona, Sheridan,
Teton, Weston,

The UnitedHealthcare MedicareDirect Essential (PFFS) H5435-001 is available to residents in Arizona, California, Georgia, Indiana, Kansas, Kentucky, Louisiana, Missouri, Montana, Nebraska, New Hampshire, North Carolina, Oklahoma, Texas, Vermont, Virginia, Wyoming, and has a in-network Maximum Out-of-Pocket limit of N/A MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in UnitedHealthcare MedicareDirect Essential (PFFS) plan you will stop paying co-pays for the rest of the year once you pay out of pocket N/A This is a very nice safety net. This plan does not provide additional Medicare prescription drug (Part-D) coverage.

UnitedHealthcare MedicareDirect Essential (PFFS) is a PFFS *. A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan offered by a contract with the Centers for Medicare & Medicaid Services (CMS) to provide you with benefits. UnitedHealthcare (instead of Medicare) will decide on how much it will cover and how much you will pay for the services you get. You may go to any Medicare approved doctor or hospital or any other health care provider that accepts both Medicare and your plans payment. A PFFS plan has no provider network, and you dont need a referral or a primary care physician for any health care or services. PFFS plans are the most flexible but a doctor will make a visit-by-visit decisions on whether to accept your provider.

Ratings for UnitedHealthcare MedicareDirect Essential (PFFS) H5435

2015 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in UnitedHealthcare MedicareDirect Essential (PFFS) Plans Performance

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Health Plan Quality Improvement

Health Plan Customer Service Rating for UnitedHealthcare MedicareDirect Essential (PFFS)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancel Screening
Cardiovascular Screening
Diabetes Care
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Ratings For Managing Chronic And Long Term Care

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Diabetes Care - Cholesterol
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions

Ratings For Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
High Risk Medication
Diabetes Treatment
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

UnitedHealthcare MedicareDirect Essential (PFFS) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld

Source: CMS.
Plans as of September 2, 2014.

Star Rating as of Oct 3, 2014.

For More Information on Ratings Please See the CMS Tech Notes Here.

Notes: Data are subject to change. All contracts for 2015 have been finalized. For 2015, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit

Includes 2015 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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