2021 UnitedHealthcare Medicare Gold (Regional PPO C-SNP) EA-R6801

UnitedHealthcare Medicare Gold (Regional PPO C-SNP) By UnitedHealthcare



UnitedHealthcare Medicare Gold (Regional PPO C-SNP) is a 2021 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 C-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.



2021 Medicare Special Needs Plan Details

Plan Name:
UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
Plan ID:
EA-R6801
Special Needs Type: Chronic or Disabling Condition
Provider: UnitedHealthcare
Plan Year:2021
Plan Type: Regional PPO
Monthly Premium C+D: $29.00


The UnitedHealthcare Medicare Gold (Regional PPO C-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 C-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 $17.30 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 C-SNP) plan has a monthly drug premium of $11.70 and a $295.0 drug deductible. This UnitedHealthcare plan offers a $11.70 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 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 $11.70. 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 C-SNP) medicare insurance plan offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $2.90 for 75% low income subsidy $5.80 for 50% and $8.80 for 25%.



Part C Premium: $17.30
Part D (Drug) Premium: $11.70
Part D Supplemental Premium $0
Total Part D Premium: $11.70
Drug Deductible: $295.0
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
75% LIS Premium: $2.90
50% LIS Premium: $5.80
25% LIS Premium: $8.80
Gap Coverage: No


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 brand-name drugs and 25% on generic drugs unless your plan offers additional coverage. This UnitedHealthcare plan does not offer additional coverage through the gap.




UnitedHealthcare Medicare Gold (Regional PPO C-SNP) Part-C Premium

UnitedHealthcare plan charges a $17.30 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.



EA-R6801 Part-D Deductible and Premium

UnitedHealthcare Medicare Gold (Regional PPO C-SNP) has a monthly drug premium of $11.70 and a $295.0 drug deductible. This UnitedHealthcare plan offers a $11.70 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 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 $11.70. 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.



EA-R6801 Formulary or Drug Coverage

UnitedHealthcare Medicare Gold (Regional PPO C-SNP) 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 $4
Tier 2 NA $12
Tier 3 NA $47
Tier 4 NA $100
Tier 5 NA 27%
Tier 12 NA $12
*Initial Coverage Phase and 30 day supply






Ratings for UnitedHealthcare Medicare Gold (Regional PPO C-SNP) EA

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 Gold (Regional PPO C-SNP) 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 Gold (Regional PPO C-SNP)

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


UnitedHealthcare Medicare Gold (Regional PPO C-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 C-SNP)

State: Medicare Plans in 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 9, 2020.

Notes: Data are subject to change. All contracts for 2020 have not been finalized. For 2020, 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 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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