0 2020 Erickson Advantage Liberty without Drugs (HMO) H5652-002 By UnitedHealthcare.
2020 Erickson Advantage Liberty without Drugs (HMO) H5652-002 By UnitedHealthcare.

2020 Medicare Advantage Plan Services for
Erickson Advantage Liberty without Drugs (HMO)


Erickson Advantage Liberty without Drugs (HMO) H5652-002 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by UnitedHealthcare available to residents in Maryland Pennsylvania Texas Colorado Massachusetts Virginia Kansas North Carolina New Jersey Michigan. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The Erickson Advantage Liberty without Drugs (HMO) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out of pocket. This can be a extremely nice safety net.

Erickson Advantage Liberty without Drugs (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

UnitedHealthcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Erickson Advantage Liberty without Drugs (HMO) 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.





2020 UnitedHealthcare Medicare Advantage Plan Details

Name:
Erickson Advantage Liberty without Drugs (HMO)
ID:
H5652-002
Provider:UnitedHealthcare
Year:2020
Type: Local HMO *
Monthly Premium C+D: $-
Part C Premium:
MOOP: $6,700






2019 Plan Services

(*2020 Plan services will be added when available)




Health plan deductible


$0



Emergency care/Urgent care


Emergency $75 per visit (always covered)
Urgent care $30 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 $0 copay
Lab services In-Network $0 copay
Diagnostic radiology services (e.g., MRI) Out-of-Network 30%
Diagnostic radiology services (e.g., MRI) In-Network $50
Outpatient x-rays Out-of-Network 30%
Outpatient x-rays In-Network $20



Hearing


Hearing exam Out-of-Network 30%
Hearing exam In-Network $20
Fitting/evaluation Not covered
Hearing aids - inner ear In-Network $380
Hearing aids - outer ear Not covered
Hearing aids - over the ear In-Network $330



Preventive dental


Office visit In-Network $35.00
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 Not covered



Vision


Routine eye exam Out-of-Network 30%
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 30% per stay
Inpatient hospital - psychiatric In-Network $0 copay per stay
Outpatient group therapy visit with a psychiatrist Out-of-Network 30%
Outpatient group therapy visit with a psychiatrist In-Network $30
Outpatient individual therapy visit with a psychiatrist Out-of-Network 30%
Outpatient individual therapy visit with a psychiatrist In-Network $30
Outpatient group therapy visit Out-of-Network 30%
Outpatient group therapy visit In-Network $0 copay
Outpatient individual therapy visit Out-of-Network 30%
Outpatient individual therapy visit In-Network $0-30



Skilled Nursing Facility


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



Rehabilitation services


Occupational therapy visit Out-of-Network 30%
Occupational therapy visit In-Network $0 copay
Physical therapy and speech and language therapy visit Out-of-Network 30%
Physical therapy and speech and language therapy visit In-Network $0 copay



Ground ambulance


Out-of-Network $150
In-Network $150



Other health plan deductibles?


In-Network No



Transportation


In-Network $0 copay



Foot care (podiatry services)


Foot exams and treatment Out-of-Network 30%
Foot exams and treatment In-Network $0 copay
Routine foot care Out-of-Network 30%
Routine foot care In-Network $0 copay



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 10%
Other Part B drugs Out-of-Network 30%
Other Part B drugs In-Network 10%



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


$2,900 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 $0 copay per stay
$0 per day for days 91 and beyond



Outpatient hospital coverage


Out-of-Network 30% per visit
In-Network $50 per visit



Doctor visits


Primary Out-of-Network 30% per visit
Primary In-Network $0 copay
Specialist Out-of-Network 30% per visit
Specialist In-Network $20 per visit



Preventive care


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


Ratings for Erickson Advantage Liberty without Drugs (HMO) H5652

2019 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
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 Erickson Advantage Liberty without Drugs (HMO) Plans Performance

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


Health Plan Customer Service Rating for Erickson Advantage Liberty without Drugs (HMO)

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


Erickson Advantage Liberty without Drugs (HMO) 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 Erickson Advantage Liberty without Drugs (HMO)

(Click county to compare all available Advantage plans)



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Source: CMS.
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, 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 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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