2019 HealthPartners UnityPoint Health Symmetry (PPO) H3416-002 By HealthPartners UnityPoint Health

2019 Medicare Advantage Plan Services for
HealthPartners UnityPoint Health Symmetry (PPO)


HealthPartners UnityPoint Health Symmetry (PPO) H3416-002 is a 2019 Medicare Advantage or Medicare Part-C plan by HealthPartners UnityPoint Health available to residents in Iowa Illinois. This plan includes additional Medicare prescription drug (Part-D) coverage. The HealthPartners UnityPoint Health Symmetry (PPO) has a monthly premium of $39.00 and has an in-network Maximum Out-of-Pocket limit of $3,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,500 out of pocket. This can be a extremely nice safety net.

HealthPartners UnityPoint Health Symmetry (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.

HealthPartners UnityPoint Health works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for HealthPartners UnityPoint Health Symmetry (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from HealthPartners UnityPoint Health 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 HealthPartners UnityPoint Health 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 HealthPartners UnityPoint Health Medicare Advantage Plan Details

Name:
HealthPartners UnityPoint Health Symmetry (PPO)
ID:
H3416-002
Provider:HealthPartners UnityPoint Health
Year:2019
Type: Local PPO
Monthly Premium C+D: $39.00
Part C Premium:$0.00
MOOP: $3,500
Part D (Drug) Premium:$39.00
Part D Supplemental Premium$0.00
Total Part D Premium:$39.00
Drug Deductible:$100.00
Tiers with No Deductible:1
Gap Coverage:Yes
Initial Coverage Limit:$3820
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced






Part-C Premium

HealthPartners UnityPoint Health 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

HealthPartners UnityPoint Health Symmetry (PPO) has a monthly drug premium of $39.00 and a $100.00 drug deductible. This HealthPartners UnityPoint Health plan offers a $39.00 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 HealthPartners UnityPoint Health 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 $39.00. 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 HealthPartners UnityPoint Health Symmetry (PPO) medicare insurance offers a $5.40 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $13.80 for 75% low income subsidy $22.20 for 50% and $30.60 for 25%.



Full LIS Premium:$5.40
75% LIS Premium:$13.80
50% LIS Premium:$22.20
25% LIS Premium:$30.60


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 HealthPartners UnityPoint Health plan does offer additional coverage through the gap.





Plan Services




Health plan deductible


$0



Emergency care/Urgent care


Emergency $90 per visit (always covered)
Urgent care $20 per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures Out-of-Network 30%
Diagnostic tests and procedures In-Network $0 copay
Lab services Out-of-Network 30%
Lab services In-Network $0 copay
Diagnostic radiology services (e.g., MRI) Out-of-Network 30%
Diagnostic radiology services (e.g., MRI) In-Network $200
Outpatient x-rays Out-of-Network 30%
Outpatient x-rays In-Network $0 copay



Hearing


Hearing exam Out-of-Network 30%
Hearing exam In-Network $20
Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered



Preventive dental


Oral exam Out-of-Network $0 copay
Oral exam In-Network $0 copay
Cleaning Out-of-Network $0 copay
Cleaning In-Network $0 copay
Fluoride treatment Not covered
Dental x-ray(s) Out-of-Network $0 copay
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 30%
Routine eye exam In-Network $0 copay
Other Not covered
Contact lenses Not covered
Eyeglasses (frames and lenses) Not covered
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades Not covered



Mental health services


Inpatient hospital - psychiatric Out-of-Network 30% per stay
Inpatient hospital - psychiatric In-Network $350 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 30%
Outpatient group therapy visit with a psychiatrist In-Network $20
Outpatient individual therapy visit with a psychiatrist Out-of-Network 30%
Outpatient individual therapy visit with a psychiatrist In-Network $20
Outpatient group therapy visit Out-of-Network 30%
Outpatient group therapy visit In-Network $20
Outpatient individual therapy visit Out-of-Network 30%
Outpatient individual therapy visit In-Network $20



Skilled Nursing Facility


Out-of-Network 30% per stay
In-Network $0 per day for days 1 through 20
$155 per day for days 21 through 100



Rehabilitation services


Occupational therapy visit Out-of-Network 30%
Occupational therapy visit In-Network $20
Physical therapy and speech and language therapy visit Out-of-Network 30%
Physical therapy and speech and language therapy visit In-Network $20



Ground ambulance


Out-of-Network $215
In-Network $225



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment Out-of-Network 30%
Foot exams and treatment In-Network $20
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 30% per item
Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 30% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Diabetes supplies Out-of-Network 30% per item
Diabetes supplies In-Network 20% per item



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


Covered



Medicare Part B drugs


Chemotherapy Out-of-Network 30%
Chemotherapy In-Network 0-20%
Other Part B drugs Out-of-Network 30%
Other Part B drugs In-Network 0-20%



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


$8,000 In and Out-of-network
$3,500 In-network



Optional supplemental benefits


No



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


In-Network No



Inpatient hospital coverage


Out-of-Network 30% per stay
In-Network $350 per day for days 1 through 4
$0 per day for days 5 through 90



Outpatient hospital coverage


Out-of-Network 30% per visit
In-Network $20-200 per visit



Doctor visits


Primary Out-of-Network 30% per visit
Primary In-Network $5 per visit
Specialist Out-of-Network 30% per visit
Specialist In-Network $20 per visit



Preventive care


Out-of-Network 30%
In-Network $0 copay






Coverage Area for HealthPartners UnityPoint Health Symmetry (PPO)

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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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