2023 AARP Medicare Advantage Patriot (HMO-POS)

AARP Medicare Advantage Patriot (HMO-POS) H0543-121 is a 2023 Medicare Advantage Plan or Part-C by UnitedHealthcare available to residents in California. This plan does not provide additional prescription drug (Part-D) coverage. UnitedHealthcare AARP Medicare Advantage Patriot (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $4,900 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $4,900 out-of-pocket. This can be an extremely nice safety net.

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-POS) 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 2023 Medicare Advantage Plan 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 if you sign up for Medicare Advantage in California.




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2023 UnitedHealthcare Medicare Advantage Plan Overview

Name:AARP Medicare Advantage Patriot (HMO-POS)
Plan ID:H0543 121 0
Provider:UnitedHealthcare
Year:2023
Type:Local HMO *
Combined Premium (C+D):$0/mo
MOOP:$4,900/yr
Similar Plan: H0543-140




What type of plan is AARP Medicare Advantage Patriot (HMO-POS)

AARP Medicare Advantage Patriot (HMO-POS) 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 primary care physician 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 primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

How much does AARP Medicare Advantage Patriot (HMO-POS) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. UnitedHealthcare charges a $0 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.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. AARP Medicare Advantage Patriot (HMO-POS) by UnitedHealthcare MOOP is $4,900. Once you spend $4,900 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.





Summary of Benefits

*2021 data this will be updated with 2023 data when available.

The benefit information provided is a summary of what AARP Medicare Advantage Patriot (HMO-POS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from UnitedHealthcare helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.




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) $0-95 copay
Diagnostic tests and procedures $0 copay
Lab services $0 copay
Outpatient x-rays $0 copay



Doctor Visits


Primary $5 copay per visit
Specialist $10 copay per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $30 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $10 copay
Routine foot care Not covered



Ground Ambulance


$250 copay



Hearing


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



Inpatient Hospital Coverage


$50 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 $50 per stay
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


$4,900 In-network



Option


No



Optional supplemental benefits


Yes



Outpatient Hospital Coverage


$0 copay



Package #1


Deductible
Monthly Premium $45.00



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 $10 copay
Physical therapy and speech and language therapy visit $10 copay



Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 47
$0 per day for days 48 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




CMS Star Ratings


Is AARP Medicare Advantage Patriot (HMO-POS) a good plan? AARP Medicare Advantage Patriot (HMO-POS) received a 4 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare AARP Medicare Advantage Patriot (HMO-POS) performance among several different plans.

2022 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
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H0543-121 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 Plans Performance

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


Health Plan Customer Service Rating for UnitedHealthcare

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


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

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for AARP Medicare Advantage Patriot (HMO-POS) requires you to live in that plan’s service area. The service area is listed below:



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How much does AARP Medicare Advantage Patriot (HMO-POS) cost?

UnitedHealthcare charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is AARP Medicare Advantage Patriot (HMO-POS) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. AARP Medicare Advantage Patriot (HMO-POS) by UnitedHealthcare MOOP is $4,900. Once you spend $4,900 you will pay nothing for Part A or Part B covered services.

What type of plan is AARP Medicare Advantage Patriot (HMO-POS)?

AARP Medicare Advantage Patriot (HMO-POS) is a Local HMO *. With a health maintenance organization you will be required to receive most of your health care from an in-network provider. HMOs require that you select a primary care physician (PCP).

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

Is AARP Medicare Advantage Patriot (HMO-POS) a good plan?

AARP Medicare Advantage Patriot (HMO-POS) received a 4 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, 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 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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*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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