2021 UnitedHealthcare Medicare Advantage Assure (HMO) H0543-202 By UnitedHealthcare.

Summary of Benefits for
2021 UnitedHealthcare Medicare Advantage Assure (HMO)


UnitedHealthcare Medicare Advantage Assure (HMO) H0543-202 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by UnitedHealthcare available to residents in California. This plan includes additional Medicare prescription drug (Part-D) coverage. The UnitedHealthcare Medicare Advantage Assure (HMO) has a monthly premium of $17.10 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out of pocket. This can be a extremely nice safety net.

UnitedHealthcare Medicare Advantage Assure (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 UnitedHealthcare Medicare Advantage Assure (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:
UnitedHealthcare Medicare Advantage Assure (HMO)
Plan ID:
H0543-202
Provider:UnitedHealthcare
Year:2021
Type: Local HMO
Monthly Premium C+D: $17.10
Part C Premium: $0
MOOP: $7,550
Part D (Drug) Premium: $17.10
Part D Supplemental Premium $0
Total Part D Premium: $17.10
Drug Deductible: $445.0
Tiers with No Deductible:0
Gap Coverage:No
Benchmark:below the regional benchmark
Type of Medicare Health:Defined Standard Benefit
Drug Benefit Type:Basic
Similar Plan: H0543-204




UnitedHealthcare Medicare Advantage Assure (HMO) Part-C Premium

UnitedHealthcare plan charges a $0 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.



H0543-202 Part-D Deductible and Premium

UnitedHealthcare Medicare Advantage Assure (HMO) has a monthly drug premium of $17.10 and a $445.0 drug deductible. This UnitedHealthcare plan offers a $17.10 Part D Basic Premium that is 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 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 $17.10. 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.



UnitedHealthcare Gap Coverage

In 2021 once you and your plan provider have spent $4130 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 prescription drugs unless your plan offers additional coverage. This UnitedHealthcare plan does not offer additional coverage through the gap.



Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The UnitedHealthcare Medicare Advantage Assure (HMO) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $4.30 for 75% low income subsidy $8.50 for 50% and $12.80 for 25%.



Full LIS Premium: $0
75% LIS Premium: $4.30
50% LIS Premium: $8.50
25% LIS Premium: $12.80


H0543-202 Formulary or Drug Coverage

UnitedHealthcare Medicare Advantage Assure (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 NA 25%
Tier 2 NA 25%
Tier 3 NA 25%
Tier 4 NA 25%
Tier 5 NA 25%
*Initial Coverage Phase and 30 day supply







2021 UnitedHealthcare Medicare Advantage Assure (HMO) Summary of Benefits




Additional Benefits


No



Comprehensive Dental


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



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) 0-20% coinsurance
Diagnostic tests and procedures $0 copay
Lab services $0 copay
Outpatient x-rays 20% coinsurance



Doctor Visits


Primary 20% coinsurance per visit
Specialist 20% coinsurance per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $65 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment 20% coinsurance
Routine foot care $0 copay



Ground Ambulance


20% coinsurance



Hearing


Fitting/evaluation Not covered
Hearing aids $0 copay
Hearing exam 20% coinsurance



Inpatient Hospital Coverage


$1,300 per stay
$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 $1,300 per stay
Outpatient group therapy visit 20% coinsurance
Outpatient group therapy visit with a psychiatrist 20% coinsurance
Outpatient individual therapy visit 20% coinsurance
Outpatient individual therapy visit with a psychiatrist 20% coinsurance



MOOP


$7,550 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


0-20% coinsurance per visit



Preventive Care


$0 copay



Preventive Dental


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



Rehabilitation Services


Occupational therapy visit 20% coinsurance
Physical therapy and speech and language therapy visit 20% coinsurance



Skilled Nursing Facility


Coming soon



Transportation


$0 copay



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 UnitedHealthcare Medicare Advantage Assure (HMO) H0543



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 UnitedHealthcare Medicare Advantage Assure (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 UnitedHealthcare Medicare Advantage Assure (HMO)

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


UnitedHealthcare Medicare Advantage Assure (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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Sun 9am-6pm EST




Coverage Area for UnitedHealthcare Medicare Advantage Assure (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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