Care Improvement Plus Dual Advantage (Regional PPO SNP) By UnitedHealthcare
Care Improvement Plus Dual Advantage (Regional PPO SNP) is a 2018 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.
Care Improvement Plus Dual Advantage (Regional PPO SNP) DS-R7444 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.
2018 Medicare Special Needs Plan Details
| Plan Name: | Care Improvement Plus Dual Advantage (Regional PPO SNP) |
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| Plan ID: | DS-R7444 |
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| Special Needs Type: | Dual-Eligible |
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| Provider: | UnitedHealthcare |
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| Plan Year: | 2018 |
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| Plan Type: | Regional PPO |
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| Monthly Premium C+D: | $22.90 |
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Coverage Area for Care Improvement Plus Dual Advantage (Regional PPO SNP)
| State: |
Georgia
South Carolina
| County: | Appling, Atkinson, Bacon, Baker,
Baldwin, Banks, Barrow,
Bartow, Ben Hill, Berrien,
Bibb, Bleckley, Brantley,
Brooks, Bryan, Bulloch,
Burke, Butts, Calhoun,
Camden, Candler, Carroll,
Catoosa, Charlton, Chatham,
Chattahoochee, Chattooga, Cherokee,
Clarke, Clay, Clayton,
Clinch, Cobb, Coffee,
Colquitt, Columbia, Cook,
Coweta, Crawford, Crisp,
Dade, Dawson, Decatur,
DeKalb, Dodge, Dooly,
Dougherty, Douglas, Early,
Echols, Effingham, Elbert,
Emanuel, Evans, Fannin,
Fayette, Floyd, Forsyth,
Franklin, Fulton, Gilmer,
Glascock, Glynn, Gordon,
Grady, Greene, Gwinnett,
Habersham, Hall, Hancock,
Haralson, Harris, Hart,
Heard, Henry, Houston,
Irwin, Jackson, Jasper,
Jeff Davis, Jefferson, Jenkins,
Johnson, Jones, Lamar,
Lanier, Laurens, Lee,
Liberty, Lincoln, Long,
Lowndes, Lumpkin, Macon,
Madison, Marion, McDuffie,
McIntosh, Meriwether, Miller,
Mitchell, Monroe, Montgomery,
Morgan, Murray, Muscogee,
Newton, Oconee, Oglethorpe,
Paulding, Peach, Pickens,
Pierce, Pike, Polk,
Pulaski, Putnam, Quitman,
Rabun, Randolph, Richmond,
Rockdale, Schley, Screven,
Seminole, Spalding, Stephens,
Stewart, Sumter, Talbot,
Taliaferro, Tattnall, Taylor,
Telfair, Terrell, Thomas,
Tift, Toombs, Towns,
Treutlen, Troup, Turner,
Twiggs, Union, Upson,
Walker, Walton, Ware,
Warren, Washington, Wayne,
Webster, Wheeler, White,
Whitfield, Wilcox, Wilkes,
Wilkinson, Worth, Abbeville,
Aiken, Allendale, Anderson,
Bamberg, Barnwell, Beaufort,
Berkeley, Calhoun, Charleston,
Cherokee, Chester, Chesterfield,
Clarendon, Colleton, Darlington,
Dillon, Dorchester, Edgefield,
Fairfield, Florence, Georgetown,
Greenville, Greenwood, Hampton,
Horry, Jasper, Kershaw,
Lancaster, Laurens, Lee,
Lexington, Marion, Marlboro,
McCormick, Newberry, Oconee,
Orangeburg, Pickens, Richland,
Saluda, Spartanburg, Sumter,
Union, Williamsburg, York,
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The Care Improvement Plus Dual Advantage (Regional PPO SNP) DS-R7444 is available to residents in Georgia, South Carolina, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage.
Care Improvement Plus Dual Advantage (Regional PPO SNP) is a Regional 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.
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 Care Improvement Plus Dual Advantage (Regional PPO SNP) plan has a monthly drug premium of $22.90 and a $405.00 drug deductible. This UnitedHealthcare plan offers a $22.90 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 $22.90. 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 Care Improvement Plus Dual Advantage (Regional 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 $5.70 for 75% low income subsidy $11.40 for 50% and $17.20 for 25%.
| Part C Premium: | $0.00 |
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| Part D (Drug) Premium: | $22.90 |
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| Part D Supplemental Premium | $0.00 |
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| Total Part D Premium: | $22.90 |
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| Drug Deductible: | $405.00 |
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| Tiers with No Deductible: | 0 |
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| Benchmark: | below the regional benchmark |
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| Type of Medicare Health Plan: | Defined Standard Benefit |
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| Drug Benefit Type: | Basic |
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| Full LIS Premium: | $0.00 |
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| 75% LIS Premium: | $5.70 |
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| 50% LIS Premium: | $11.40 |
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| 25% LIS Premium: | $17.20 |
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| Initial Coverage Limit: | $3750 |
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| Gap Coverage: | No |
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Gap Coverage
In 2018 once you and your plan provider have spent $3,750 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 35% for brand-name drugs and 44% on generic drugs unless your plan offers additional coverage. This UnitedHealthcare plan does not offer additional coverage through the gap.
Plan Services
Health plan deductible
Diagnostic procedures/lab services/imaging
| Diagnostic tests and procedures |
In-Network |
$0 copay |
| Diagnostic tests and procedures |
Out-of-Network |
20% |
| Lab services |
In-Network |
$0 copay |
| Lab services |
Out-of-Network |
$0 copay |
| Diagnostic radiology services (e.g., MRI) |
In-Network |
$0 copay |
| Diagnostic radiology services (e.g., MRI) |
Out-of-Network |
20% |
| Outpatient x-rays |
In-Network |
$0 copay |
| Outpatient x-rays |
Out-of-Network |
20% |
Hearing
| Hearing exam |
In-Network |
$0 copay |
| Hearing exam |
Out-of-Network |
$0 copay |
| Fitting/evaluation |
|
Not covered |
| Hearing aids - inner ear |
In-Network |
$0 copay |
| Hearing aids - inner ear |
Out-of-Network |
$0 copay |
| Hearing aids - outer ear |
|
Not covered |
| Hearing aids - over the ear |
In-Network |
$0 copay |
| Hearing aids - over the ear |
Out-of-Network |
$0 copay |
Preventive dental
| Office visit |
In-Network |
$0.00 |
| Office visit |
Out-of-Network |
$0 copay |
| Oral exam |
|
Covered under office visit |
| Cleaning |
|
Covered under office visit |
| Fluoride treatment |
|
Not covered |
| Dental x-ray(s) |
|
Covered under office visit |
Comprehensive dental
| Non-routine services |
|
Not covered |
| Diagnostic services |
|
Not covered |
| Restorative services |
|
Not covered |
| Endodontics |
|
Not covered |
| Periodontics |
|
Not covered |
| Extractions |
|
Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services |
In-Network |
$0 copay |
| Prosthodontics, other oral/maxillofacial surgery, other services |
Out-of-Network |
$0 copay |
Vision
| Routine eye exam |
In-Network |
$0 copay |
| Routine eye exam |
Out-of-Network |
$0 copay |
| Other |
|
Not covered |
| Contact lenses |
In-Network |
$0 copay |
| Contact lenses |
Out-of-Network |
$0 copay |
| Eyeglasses (frames and lenses) |
In-Network |
$0 copay |
| Eyeglasses (frames and lenses) |
Out-of-Network |
$0 copay |
| Eyeglass frames |
|
Not covered |
| Eyeglass lenses |
|
Not covered |
| Upgrades |
|
Not covered |
Mental health services
| |
In-Network |
$0 copay |
| |
Out-of-Network |
$1,300 per stay |
| Outpatient group therapy visit with a psychiatrist |
In-Network |
$0 copay |
| Outpatient group therapy visit with a psychiatrist |
Out-of-Network |
$0 copay |
| Outpatient individual therapy visit with a psychiatrist |
In-Network |
$0 copay |
| Outpatient individual therapy visit with a psychiatrist |
Out-of-Network |
$0 copay |
| Outpatient group therapy visit |
In-Network |
$0 copay |
| Outpatient group therapy visit |
Out-of-Network |
$0 copay |
| Outpatient individual therapy visit |
In-Network |
$0 copay |
| Outpatient individual therapy visit |
Out-of-Network |
$0 copay |
Skilled Nursing Facility
| |
In-Network |
$0 copay |
| |
Out-of-Network |
Coming soon |
Rehabilitation services
| Occupational therapy visit |
In-Network |
$0 copay |
| Occupational therapy visit |
Out-of-Network |
$0 copay |
| Physical therapy and speech and language therapy visit |
In-Network |
$0 copay |
| Physical therapy and speech and language therapy visit |
Out-of-Network |
$0 copay |
Ambulance
| |
In-Network |
$0 copay |
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Out-of-Network |
20% |
Transportation
| |
In-Network |
$0 copay |
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Out-of-Network |
$0 copay |
Other health plan deductibles?
Foot care (podiatry services)
| Foot exams and treatment |
In-Network |
$0 copay |
| Foot exams and treatment |
Out-of-Network |
$0 copay |
| Routine foot care |
In-Network |
$0 copay |
| Routine foot care |
Out-of-Network |
$0 copay |
Medical equipment/supplies
| Durable medical equipment (e.g., wheelchairs, oxygen) |
In-Network |
$0 copay |
| Durable medical equipment (e.g., wheelchairs, oxygen) |
Out-of-Network |
20% per item |
| Prosthetics (e.g., braces, artificial limbs) |
In-Network |
$0 copay |
| Prosthetics (e.g., braces, artificial limbs) |
Out-of-Network |
20% per item |
| Diabetes supplies |
In-Network |
$0 copay |
| Diabetes supplies |
Out-of-Network |
20-30% per item |
Wellness programs (e.g. fitness nursing hotline)
Medicare Part B drugs
| Chemotherapy |
In-Network |
$0 copay |
| Chemotherapy |
Out-of-Network |
20% |
| Other Part B drugs |
In-Network |
$0 copay |
| Other Part B drugs |
Out-of-Network |
20% |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$6,700 In and Out-of-network
$6,700 In-network |
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Optional supplemental benefits
Inpatient hospital coverage
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In-Network |
$0 copay |
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Out-of-Network |
$1,300 per stay |
Outpatient hospital coverage
| |
In-Network |
$0 copay |
| |
Out-of-Network |
20% per visit |
Doctor visits
| Primary |
In-Network |
$0 copay |
| Primary |
Out-of-Network |
$0 copay |
| Specialist |
In-Network |
$0 copay |
| Specialist |
Out-of-Network |
$0 copay |
Preventive care
| |
In-Network |
$0 copay |
| |
Out-of-Network |
$0 copay |
Emergency care/Urgent care
| Emergency |
|
$0 copay |
| Urgent care |
|
$0 copay |
Ratings for Care Improvement Plus Dual Advantage (Regional PPO SNP) DS
| 2018 Overall Rating | | |
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| Part C Summary Rating | | |
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| Part D Summary Rating | | |
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| Staying Healthy: Screenings, Tests, Vaccines | | |
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| Managing Chronic (Long Term) Conditions | | |
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| Member Experience with Health Plan | | |
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| Complaints and Changes in Plans Performance | | |
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| Health Plan Customer Service | | |
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| Drug Plan Customer Service | | |
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| Complaints and Changes in the Drug Plan | | |
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| Member Experience with the Drug Plan | | |
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| Drug Safety and Accuracy of Drug Pricing | | |
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Member Experience with Health Plan
| Total Experience Rating | | |
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| Getting Needed Care | | |
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| Timely Care and Appointments | | |
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| Customer Service | | |
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| Health Care Quality | | |
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| Rating of Health Plan | | |
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| Care Coordination | | |
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Member Complaints and Changes in Care Improvement Plus Dual Advantage (Regional PPO SNP) Plans Performance
| Total Rating | | |
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| Members Leaving the Plan | | |
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| Complaints about Health Plan | | |
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| Beneficiary Access | | |
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| Health Plan Quality Improvement | | |
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Health Plan Customer Service Rating for Care Improvement Plus Dual Advantage (Regional PPO SNP)
| Total Customer Service Rating | | |
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| Timely Decisions About Appeals | | |
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| Reviewing Appeals Decisions | | |
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| Call Center, TTY, Foreign Language | | |
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Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating | | |
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| Breast Cancer Screening | | |
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| Colorectal Cancer Screening | | |
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| Annual Flu Vaccine | | |
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| Improving Physical | | |
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| Improving Mental Health | | |
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| Monitoring Physical Activity | | |
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| Adult BMI Assessment | | |
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Managing Chronic And Long Term Care for Older Adults
| Total Rating | | |
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| SNP Care Management | | |
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| Medication Review | | |
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| Functional Status Assessment | | |
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| Pain Screening | | |
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| Osteoporosis Management | | |
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| Diabetes Care - Eye Exam | | |
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| Diabetes Care - Kidney Disease | | |
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| Diabetes Care - Blood Sugar | | |
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| Controlling Blood Pressure | | |
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| Rheumatoid Arthritis | | |
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| Improving Bladder Control | | |
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| Reducing Risk of Falling | | |
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| Plan - Cause Readmissions | | |
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Member Experience with the Drug Plan
| Total Rating | | |
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| Rating of Drug Plan | | |
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| Getting Needed Prescription Drugs | | |
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Drug Safety and Accuracy of Drug Pricing
| Total Rating | | |
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| MPF Price Accuracy | | |
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| Drug Adherence for Diabetes Medications | | |
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| Drug Adherence for Hypertension (RAS antagonists) | | |
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| Drug Adherence for Cholesterol (Statins) | | |
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| MTM Program Completion Rate for CMR | | |
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Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating | | |
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| Complaints about the Drug Plan | | |
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| Members Choosing to Leave the Plan | | |
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| Beneficiary Access | | |
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| Drug Plan Quality Improvement | | |
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Care Improvement Plus Dual Advantage (Regional PPO SNP) Drug Plan Customer Service ratings
| Total Rating | | |
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| Appeals Auto Forward | | |
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| Appeals Upheld | | |
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| Call Center, TTY, Foreign Language | | |
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Source: CMS.
Plans as of September 2, 2017.
Star Rating as of September 6, 2017.
For More Information on Ratings Please See the CMS Tech Notes Here.
Notes: Data are subject to change. All contracts for 2018 have not been finalized. For 2018, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.
Includes 2018 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.
