2019 AARP MedicareComplete Choice (PPO) H1278-002 By UnitedHealthcare

2019 Medicare Advantage Plan Services for
AARP MedicareComplete Choice (PPO)


AARP MedicareComplete Choice (PPO) H1278-002 is a 2019 Medicare Advantage or Medicare Part-C plan by UnitedHealthcare available to residents in Nebraska Iowa. This plan includes additional Medicare prescription drug (Part-D) coverage. The AARP MedicareComplete Choice (PPO) has a monthly premium of $28.00 and has an in-network Maximum Out-of-Pocket limit of $5,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,500 out of pocket. This can be a extremely nice safety net.

AARP MedicareComplete Choice (PPO) 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.

UnitedHealthcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for AARP MedicareComplete Choice (PPO) 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. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from UnitedHealthcare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



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2019 UnitedHealthcare Medicare Advantage Plan Details

Name:
AARP MedicareComplete Choice (PPO)
ID:
H1278-002
Provider:UnitedHealthcare
Year:2019
Type: Local PPO
Monthly Premium C+D: $28.00
Part C Premium:$0.00
MOOP: $5,500
Part D (Drug) Premium:$28.00
Part D Supplemental Premium$0.00
Total Part D Premium:$28.00
Drug Deductible:$250.00
Tiers with No Deductible:1
Gap Coverage:No
Initial Coverage Limit:$3820
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced






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

AARP MedicareComplete Choice (PPO) has a monthly drug premium of $28.00 and a $250.00 drug deductible. This UnitedHealthcare plan offers a $28.00 Part D Basic Premium that is not 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 $28.00. 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 AARP MedicareComplete Choice (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $7.00 for 75% low income subsidy $14.00 for 50% and $21.00 for 25%.



Full LIS Premium:$0.00
75% LIS Premium:$7.00
50% LIS Premium:$14.00
25% LIS Premium:$21.00


Gap Coverage

In 2019 once you and your plan provider have spent $3820 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for brand-name drugs and 37% 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


$0



Emergency care/Urgent care


Emergency $90 per visit (always covered)
Urgent care $30-40 per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures Out-of-Network 40%
Diagnostic tests and procedures In-Network $20
Lab services Out-of-Network $10
Lab services In-Network $10
Diagnostic radiology services (e.g., MRI) Out-of-Network 40%
Diagnostic radiology services (e.g., MRI) In-Network $100
Outpatient x-rays Out-of-Network $21
Outpatient x-rays In-Network $14



Hearing


Hearing exam Out-of-Network $70
Hearing exam In-Network $10
Fitting/evaluation Not covered
Hearing aids Out-of-Network $100-170
Hearing aids In-Network $100-1,825



Preventive dental


Oral exam Out-of-Network 50%
Oral exam In-Network $0 copay
Cleaning Out-of-Network 50%
Cleaning In-Network $0 copay
Fluoride treatment Not covered
Dental x-ray(s) Out-of-Network 50%
Dental x-ray(s) In-Network $0 copay



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 Not covered



Vision


Routine eye exam Out-of-Network $70
Routine eye exam In-Network $0 copay
Other Not covered
Contact lenses Out-of-Network 40%
Contact lenses In-Network $0 copay
Eyeglasses (frames and lenses) Not covered
Eyeglass frames Out-of-Network 40%
Eyeglass frames In-Network $0 copay
Eyeglass lenses Out-of-Network 40%
Eyeglass lenses In-Network $0 copay
Upgrades Not covered



Mental health services


Inpatient hospital - psychiatric Out-of-Network 40% per stay
Inpatient hospital - psychiatric In-Network $395 per day for days 1 through 4
$0 per day for days 5 through 90
Outpatient group therapy visit with a psychiatrist Out-of-Network $50-60
Outpatient group therapy visit with a psychiatrist In-Network $30
Outpatient individual therapy visit with a psychiatrist Out-of-Network $50-60
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit Out-of-Network $50-60
Outpatient group therapy visit In-Network $30
Outpatient individual therapy visit Out-of-Network $50-60
Outpatient individual therapy visit In-Network $40



Skilled Nursing Facility


Out-of-Network 40% per stay
In-Network $0 per day for days 1 through 20
$160 per day for days 21 through 55
$0 per day for days 5



Rehabilitation services


Occupational therapy visit Out-of-Network $70
Occupational therapy visit In-Network $40
Physical therapy and speech and language therapy visit Out-of-Network $70
Physical therapy and speech and language therapy visit In-Network $40



Ground ambulance


Out-of-Network $225
In-Network $225



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment Out-of-Network $70
Foot exams and treatment In-Network $50
Routine foot care Out-of-Network $70
Routine foot care In-Network $50



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 50% per item
Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 40% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Diabetes supplies Out-of-Network 40% per item
Diabetes supplies In-Network $0 per item



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy Out-of-Network 40%
Chemotherapy In-Network 20%
Other Part B drugs Out-of-Network 40%
Other Part B drugs In-Network 20%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$10,000 In and Out-of-network
$5,500 In-network



Optional supplemental benefits


Yes



Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?


In-Network No



Inpatient hospital coverage


Out-of-Network 40% per stay
In-Network $395 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91



Outpatient hospital coverage


Out-of-Network 40% per visit
In-Network $395 per visit



Doctor visits


Primary Out-of-Network $30 per visit
Primary In-Network $10 per visit
Specialist Out-of-Network $70 per visit
Specialist In-Network $50 per visit



Preventive care


Out-of-Network 0-40%
In-Network $0 copay






Coverage Area for AARP MedicareComplete Choice (PPO)

(Click county to compare all available Advantage plans)



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Source: CMS.
Data as of September 2, 2018.
Star Rating as of October 10, 2018.
For More Information on Ratings Please See the CMS Tech Notes.
Notes: Data are subject to change as contracts are finalized. For 2019, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2019 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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