2021 AARP Medicare Advantage Patriot (HMO) H0755-037 By UnitedHealthcare.

Summary of Benefits for
2021 AARP Medicare Advantage Patriot (HMO)


AARP Medicare Advantage Patriot (HMO) H0755-037 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by UnitedHealthcare available to residents in New Jersey. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The AARP Medicare Advantage Patriot (HMO) has a monthly premium of $0 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.

AARP Medicare Advantage Patriot (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 AARP Medicare Advantage Patriot (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.




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2021 UnitedHealthcare Medicare Advantage Plan Costs

Name:
AARP Medicare Advantage Patriot (HMO)
Plan ID:
H0755-037
Provider:UnitedHealthcare
Year:2021
Type: Local HMO *
Monthly Premium C+D: $0
Part C Premium:
MOOP: $6,700
Similar Plan: H0755-038






2021 AARP Medicare Advantage Patriot (HMO) Summary of Benefits




Additional Benefits


No



Comprehensive Dental


Diagnostic services $0 copay
Endodontics Not covered
Extractions Not covered
Non-routine services Not covered
Periodontics Not covered
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay
Restorative services $0 copay



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $0-155 copay
Diagnostic tests and procedures $30 copay
Lab services $0 copay
Outpatient x-rays $30 copay



Doctor Visits


Primary $5 copay per visit
Specialist $30 copay per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $20-40 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $30 copay
Routine foot care $30 copay



Ground Ambulance


$250 copay



Hearing


Fitting/evaluation Not covered
Hearing aids $375-2,075 copay
Hearing exam $0 copay



Inpatient Hospital Coverage


$390 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond



Medical Equipment/Supplies


Diabetes supplies $0 copay per item
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $390 per day for days 1 through 4
$0 per day for days 5 through 90
Outpatient group therapy visit $15 copay
Outpatient group therapy visit with a psychiatrist $15 copay
Outpatient individual therapy visit $25 copay
Outpatient individual therapy visit with a psychiatrist $25 copay



MOOP


$6,700 In-network



Option


No



Optional supplemental benefits


Yes



Outpatient Hospital Coverage


$0-325 copay per visit



Package #1


Deductible
Monthly Premium $38.00



Preventive Care


$0 copay



Preventive Dental


Cleaning $0 copay
Dental x-ray(s) $0 copay
Fluoride treatment $0 copay
Oral exam $0 copay



Rehabilitation Services


Occupational therapy visit $30 copay
Physical therapy and speech and language therapy visit $30 copay



Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 57
$0 per day for days 58 through 100



Transportation


Not covered



Vision


Contact lenses $0 copay
Eyeglass frames Not covered
Eyeglass lenses Not covered
Eyeglasses (frames and lenses) $0 copay
Other Not covered
Routine eye exam $0 copay
Upgrades Not covered



Wellness Programs (e.g. fitness nursing hotline)


Covered




Reviews for AARP Medicare Advantage Patriot (HMO) H0755



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
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in AARP Medicare Advantage Patriot (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals


Health Plan Customer Service Rating for AARP Medicare Advantage Patriot (HMO)

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


AARP Medicare Advantage Patriot (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



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1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST




Coverage Area for AARP Medicare Advantage Patriot (HMO)

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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, 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 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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