UnitedHealthcare Nursing Home Plan (PPO SNP) By UnitedHealthcare
UnitedHealthcare Nursing Home Plan (PPO SNP) is a 2015 Medicare Advantage Special Needs Plan plan by UnitedHealthcare. This plan from UnitedHealthcare works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from UnitedHealthcare and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. UnitedHealthcare Nursing Home Plan (PPO SNP) H1108-001 is an Institutional SNP (I-SNP). An Institutional SNP is for beneficiaries who live in an institution such as a nursing home or require nursing care at home. If you live in an institution like a nursing home or hospital you can join any Medicare SNP you qualify for or switch plans at any time.
2015 Medicare Special Needs Plan Details
| Plan Name: | UnitedHealthcare Nursing Home Plan (PPO SNP) |
|---|---|
| Plan ID: | H1108-001 |
| Special Needs Type: | Institutional |
| Provider: | UnitedHealthcare |
| Plan Year: | 2015 |
| Plan Type: | Local PPO |
| Monthly Premium C+D: | $25.30 |
Coverage Area for UnitedHealthcare Nursing Home Plan (PPO SNP)
The UnitedHealthcare Nursing Home Plan (PPO SNP) H1108-001 is available to residents in Georgia, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. UnitedHealthcare Nursing Home Plan (PPO SNP) is a Local PPO. A preferred provider organization (PPO) is a medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
Ratings for UnitedHealthcare Nursing Home Plan (PPO SNP) H1108
| 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 Nursing Home Plan (PPO SNP) Plans Performance
| Total Rating | ||
|---|---|---|
| Members Leaving the Plan | ||
| Complaints about Health Plan | ||
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for UnitedHealthcare Nursing Home Plan (PPO SNP)
| 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 Plan’s Performance
| Total Rating | ||
|---|---|---|
| Complaints about the Drug Plan | ||
| Members Choosing to Leave the Plan | ||
| Drug Plan Quality Improvement |
UnitedHealthcare Nursing Home Plan (PPO SNP) Drug Plan Customer Service ratings
| Total Rating | ||
|---|---|---|
| Appeals Auto–Forward | ||
| Appeals Upheld |
Part-C Premium
UnitedHealthcare plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
The UnitedHealthcare Nursing Home Plan (PPO SNP) plan has a monthly drug premium of $25.30 and a $320.00 drug deductible. This UnitedHealthcare plan offers a $25.30 Part D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by UnitedHealthcare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $25.30. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Premium Assistance
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The UnitedHealthcare Nursing Home Plan (PPO SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.30 for 75% low income subsidy $12.60 for 50% and $19.00 for 25%.
| Part C Premium: | $0.00 |
|---|---|
| Part D (Drug) Premium: | $25.30 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $25.30 |
| Drug Deductible: | $320.00 |
| Tiers with No Deductible: | 0 |
| Benchmark: | below the regional benchmark |
| Type of Medicare Health Plan: | Defined Standard Benefit |
| Drug Benefit Type: | Basic |
| Full LIS Premium: | $0.00 |
| 75% LIS Premium: | $6.30 |
| 50% LIS Premium: | $12.60 |
| 25% LIS Premium: | $19.00 |
| Inital Coverage Limit: | $2960 |
| Gap Coverage: | No |
Gap Coverage
In 2015 once you and your plan provider have spent $2,960 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will still receive a 55% discount on brand-name drugs and a 35% discount on generic drugs unless your plan offers additional coverage. This UnitedHealthcare plan does not offer additional coverage through the gap.
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
Includes 2015 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.