2022 UnitedHealthcare MedicareDirect Rx (PFFS)


UnitedHealthcare MedicareDirect Rx (PFFS) H5435-024 is a 2022 Medicare Advantage Plan or Part-C by UnitedHealthcare available to residents in Wyoming and Nebraska. This plan includes additional prescription drug (Part-D) coverage. The UnitedHealthcare MedicareDirect Rx (PFFS) has a monthly premium of $74.00 and has an in-network maximum out-of-pocket limit of $- (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $- out-of-pocket. This can be a extremely nice safety net.

UnitedHealthcare MedicareDirect Rx (PFFS) is a PFFS. A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan offered by a contract with the Centers for Medicare & Medicaid Services (CMS) to provide you with benefits. UnitedHealthcare (instead of Medicare) will decide on how much it will cover and how much you will pay for the services you get. You may go to any Medicare approved doctor or hospital or any other health care provider that accepts both Medicare and your plans payment. A PFFS plan has no provider network, and you dont need a referral or a primary care physician for any health care or services. PFFS plans are the most flexible but a doctor will make a visit-by-visit decisions on whether to accept your provider.

UnitedHealthcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for UnitedHealthcare MedicareDirect Rx (PFFS) 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 you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from UnitedHealthcare except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.




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2022 UnitedHealthcare Medicare Advantage Plan Costs

Name:
UnitedHealthcare MedicareDirect Rx (PFFS)
Plan ID:
H5435-024
Provider:UnitedHealthcare
Year:2022
Type: PFFS
Monthly Premium C+D: $74.00
Part C Premium:$36.70
MOOP: $-
Part D (Drug) Premium:$37.30
Part D Supplemental Premium$0.00
Total Part D Premium:$37.30
Drug Deductible:$295.00
Tiers with No Deductible:1
Gap Coverage:No
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H5435-001




UnitedHealthcare MedicareDirect Rx (PFFS) Part-C Premium

UnitedHealthcare charges a $36.70 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.



H5435-024 Part-D Deductible and Premium

UnitedHealthcare MedicareDirect Rx (PFFS) has a monthly drug premium of $37.30 and a $295.00 drug deductible. This UnitedHealthcare plan offers a $37.30 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 $37.30 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.



UnitedHealthcare Gap Coverage

In 2022 once you and your plan provider have spent $4430 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 MedicareDirect Rx (PFFS) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $9.30 for 75% low income subsidy $18.60 for 50% and $28.00 for 25%.



Full LIS Premium:$0.00
75% LIS Premium:$9.30
50% LIS Premium:$18.60
25% LIS Premium:$28.00


H5435-024 Formulary or Drug Coverage

UnitedHealthcare MedicareDirect Rx (PFFS) 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. You can see complete 2022 UnitedHealthcare MedicareDirect Rx (PFFS) H5435-024 Formulary here.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 NA $4
Tier 2 NA $14
Tier 3 NA $47
Tier 4 NA $100
Tier 5 NA 28%
*Initial Coverage Phase and 30 day supply





2021 UnitedHealthcare MedicareDirect Rx (PFFS) Summary of Benefits

*This will be updated with 2022 data when available.



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) $0-160 copay
Diagnostic tests and procedures $25 copay
Lab services $0 copay
Outpatient x-rays $15 copay



Doctor Visits


Primary $25 copay per visit
Specialist $50 copay per visit



Emergency care/Urgent Care


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



Foot Care (podiatry services)


Foot exams and treatment $50 copay
Routine foot care $50 copay



Ground Ambulance


$250 copay



Hearing


Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered
Hearing exam $20 copay



Inpatient Hospital Coverage


$395 per day for days 1 through 4
$0 per day for days 5 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 $395 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



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$0-395 copay 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 $40 copay
Physical therapy and speech and language therapy visit $40 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 Not covered
Eyeglass frames Not covered
Eyeglass lenses Not covered
Eyeglasses (frames and lenses) Not covered
Other Not covered
Routine eye exam $0 copay
Upgrades Not covered



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings for UnitedHealthcare MedicareDirect Rx (PFFS) H5435



2021 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
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
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
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in UnitedHealthcare MedicareDirect Rx (PFFS) Plans Performance

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


Health Plan Customer Service Rating for UnitedHealthcare MedicareDirect Rx (PFFS)

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


UnitedHealthcare MedicareDirect Rx (PFFS) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


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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Coverage Area for UnitedHealthcare MedicareDirect Rx (PFFS)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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