2019 UnitedHealthcare Medicare Gold (Regional PPO SNP) EA-R6801

UnitedHealthcare Medicare Gold (Regional PPO SNP) By UnitedHealthcare



UnitedHealthcare Medicare Gold (Regional PPO SNP) is a 2019 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 Medicare Gold (Regional PPO SNP) EA-R6801 is a Chronic Condition SNP (C-SNP). A Chronic Condition SNP is for beneficiaries with the following severe or disabling chronic conditions: . If you have Medicare and you develop certain severe or disabling conditions you can join a Medicare SNP designed to serve people with those conditions at any time.



2019 Medicare Special Needs Plan Details

Plan Name:
UnitedHealthcare Medicare Gold (Regional PPO SNP)
Plan ID:
EA-R6801
Special Needs Type: Chronic or Disabling Condition
Provider: UnitedHealthcare
Plan Year:2019
Plan Type: Regional PPO
Monthly Premium C+D: $14.00


COMPARE AND SAVE ON MEDICARE INSURANCE




The UnitedHealthcare Medicare Gold (Regional PPO SNP) EA-R6801 is available to residents in Texas, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. UnitedHealthcare Medicare Gold (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 $7.50 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 Medicare Gold (Regional PPO SNP) plan has a monthly drug premium of $6.50 and a $295.00 drug deductible. This UnitedHealthcare plan offers a $6.50 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 $6.50. 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 Medicare Gold (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 $1.60 for 75% low income subsidy $3.20 for 50% and $4.90 for 25%.



Part C Premium: $7.50
Part D (Drug) Premium: $6.50
Part D Supplemental Premium $0.00
Total Part D Premium: $6.50
Drug Deductible: $295.00
Tiers with No Deductible: 1
Benchmark: not below the regional benchmark
Type of Medicare Health Plan: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $0.00
75% LIS Premium: $1.60
50% LIS Premium: $3.20
25% LIS Premium: $4.90
Initial Coverage Limit:$3820
Gap Coverage: No


Gap Coverage

In 2019 once you and your plan provider have spent $3,820 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 20%
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 20%
Diagnostic radiology services (e.g., MRI) In-Network 20%
Outpatient x-rays Out-of-Network $14
Outpatient x-rays In-Network $14



Hearing


Hearing exam Out-of-Network $20
Hearing exam In-Network $10
Fitting/evaluation Not covered
Hearing aids Out-of-Network $300-370
Hearing aids In-Network $300-2,025



Preventive dental


Oral exam Not covered
Cleaning Not covered
Fluoride treatment Not covered
Dental x-ray(s) Not covered



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 $20
Routine eye exam In-Network $20
Other Not covered
Contact lenses Out-of-Network $0 copay
Contact lenses In-Network $0 copay
Eyeglasses (frames and lenses) Out-of-Network $0 copay
Eyeglasses (frames and lenses) In-Network $0 copay
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades Not covered



Mental health services


Inpatient hospital - psychiatric Out-of-Network $264 per day for days 1 through 6
$0 per day for days 7 through 90
Inpatient hospital - psychiatric In-Network $264 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient group therapy visit with a psychiatrist Out-of-Network $30-40
Outpatient group therapy visit with a psychiatrist In-Network $30
Outpatient individual therapy visit with a psychiatrist Out-of-Network $30-40
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit Out-of-Network $30-40
Outpatient group therapy visit In-Network $30
Outpatient individual therapy visit Out-of-Network $30-40
Outpatient individual therapy visit In-Network $40



Skilled Nursing Facility


Out-of-Network $0 per day for days 1 through 20
$160 per day for days 21 through 62
$0 per day for days 6
In-Network $0 per day for days 1 through 20
$160 per day for days 21 through 62
$0 per day for days 6



Rehabilitation services


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



Ground ambulance


Out-of-Network $250
In-Network $250



Other health plan deductibles?


In-Network No



Transportation


Out-of-Network 75%
In-Network $0 copay



Foot care (podiatry services)


Foot exams and treatment Out-of-Network $0 copay
Foot exams and treatment In-Network $0 copay
Routine foot care Out-of-Network $0 copay
Routine foot care In-Network $0 copay



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 20% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Diabetes supplies Out-of-Network 20% per item
Diabetes supplies In-Network $0 copay



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


Covered



Medicare Part B drugs


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



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


$6,700 In and Out-of-network
$6,700 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 $264 per day for days 1 through 7
$0 per day for days 8 and beyond
In-Network $264 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 91



Outpatient hospital coverage


Out-of-Network 20% per visit
In-Network 20% per visit



Doctor visits


Primary Out-of-Network $20 per visit
Primary In-Network $10 per visit
Specialist Out-of-Network $45 per visit
Specialist In-Network $45 per visit



Preventive care


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



Ratings for UnitedHealthcare Medicare Gold (Regional PPO SNP) EA

2018 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


Staying Healthy, Screening, Testing, & Vaccines

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


Managing Chronic And Long Term Care for Older Adults

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
Controlling Blood Pressure
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Plan All-Cause Readmissions
Statin Therapy


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 Medicare Gold (Regional PPO SNP) Plans Performance

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


Health Plan Customer Service Rating for UnitedHealthcare Medicare Gold (Regional PPO SNP)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


UnitedHealthcare Medicare Gold (Regional PPO SNP) Drug Plan Customer Service ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld


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


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
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area for UnitedHealthcare Medicare Gold (Regional PPO SNP)

State: Texas
County:Anderson, Andrews, Angelina, Aransas,
Archer, Armstrong, Atascosa,
Austin, Bailey, Bandera,
Bastrop, Baylor, Bee,
Bell, Bexar, Blanco,
Borden, Bosque, Bowie,
Brazoria, Brazos, Brewster,
Briscoe, Brooks, Brown,
Burleson, Burnet, Caldwell,
Calhoun, Callahan, Cameron,
Camp, Carson, Cass,
Castro, Chambers, Cherokee,
Childress, Clay, Cochran,
Coke, Coleman, Collin,
Collingsworth, Colorado, Comal,
Comanche, Concho, Cooke,
Coryell, Cottle, Crane,
Crockett, Crosby, Culberson,
Dallam, Dallas, Dawson,
Deaf Smith, Delta, Denton,
DeWitt, Dickens, Dimmit,
Donley, Duval, Eastland,
Ector, Edwards, El Paso,
Ellis, Erath, Falls,
Fannin, Fayette, Fisher,
Floyd, Foard, Fort Bend,
Franklin, Freestone, Frio,
Gaines, Galveston, Garza,
Gillespie, Glasscock, Goliad,
Gonzales, Gray, Grayson,
Gregg, Grimes, Guadalupe,
Hale, Hall, Hamilton,
Hansford, Hardeman, Hardin,
Harris, Harrison, Hartley,
Haskell, Hays, Hemphill,
Henderson, Hidalgo, Hill,
Hockley, Hood, Hopkins,
Houston, Howard, Hudspeth,
Hunt, Hutchinson, Irion,
Jack, Jackson, Jasper,
Jeff Davis, Jefferson, Jim Hogg,
Jim Wells, Johnson, Jones,
Karnes, Kaufman, Kendall,
Kenedy, Kent, Kerr,
Kimble, King, Kinney,
Kleberg, Knox, La Salle,
Lamar, Lamb, Lampasas,
Lavaca, Lee, Leon,
Liberty, Limestone, Lipscomb,
Live Oak, Llano, Loving,
Lubbock, Lynn, Madison,
Marion, Martin, Mason,
Matagorda, Maverick, McCulloch,
McLennan, McMullen, Medina,
Menard, Midland, Milam,
Mills, Mitchell, Montague,
Montgomery, Moore, Morris,
Motley, Nacogdoches, Navarro,
Newton, Nolan, Nueces,
Ochiltree, Oldham, Orange,
Palo Pinto, Panola, Parker,
Parmer, Pecos, Polk,
Potter, Presidio, Rains,
Randall, Reagan, Real,
Red River, Reeves, Refugio,
Roberts, Robertson, Rockwall,
Runnels, Rusk, Sabine,
San Augustine, San Jacinto, San Patricio,
San Saba, Schleicher, Scurry,
Shackelford, Shelby, Sherman,
Smith, Somervell, Starr,
Stephens, Sterling, Stonewall,
Sutton, Swisher, Tarrant,
Taylor, Terrell, Terry,
Throckmorton, Titus, Tom Green,
Travis, Trinity, Tyler,
Upshur, Upton, Uvalde,
Val Verde, Van Zandt, Victoria,
Walker, Waller, Ward,
Washington, Webb, Wharton,
Wheeler, Wichita, Wilbarger,
Willacy, Williamson, Wilson,
Winkler, Wise, Wood,
Yoakum, Young, Zapata,
Zavala,


Source: CMS.

Plans as of September 2, 2018.

Star Rating as of October 10, 2018.

Notes: Data are subject to change. All contracts for 2019 have not been finalized. For 2019, 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 2019 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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