2023 UnitedHealthcare MedicareDirect Rx (PFFS)

UnitedHealthcare MedicareDirect Rx (PFFS) H5435-024 is a 2023 Medicare Advantage Plan or Part-C by UnitedHealthcare available to residents in Wyoming and Nebraska. This plan includes additional prescription drug (Part-D) coverage. UnitedHealthcare UnitedHealthcare MedicareDirect Rx (PFFS) has a monthly premium of $92.00 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 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 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 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 Wyoming or Medicare Advantage in Nebraska.




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2023 UnitedHealthcare Medicare Advantage Plan Overview

Name:UnitedHealthcare MedicareDirect Rx (PFFS)
Plan ID:H5435 024 0
Provider:UnitedHealthcare
Year:2023
Type:PFFS
Combined Premium (C+D):$92.00/mo
Part C Premium:$52.60/mo
MOOP:$-/yr
Part D (Drug) Premium:$39.40/mo
Part D Supplemental Premium$0/mo
Total Part D Premium:$39.40/mo
Drug Deductible:$295.00/yr
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




What type of plan is UnitedHealthcare MedicareDirect Rx (PFFS)

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.



How much does UnitedHealthcare MedicareDirect Rx (PFFS) cost?


Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. UnitedHealthcare charges a $92.00 consolidated premium. The Part C premium is $52.60 this charge 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

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. UnitedHealthcare MedicareDirect Rx (PFFS) has a monthly drug premium of $39.40 and a $295.00 drug deductible. This UnitedHealthcare plan offers a $39.40 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 $39.40. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.


UnitedHealthcare Gap Coverage

In 2023 once you and your plan provider have spent $4660 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.


Extra Help Premium Assistance

The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The UnitedHealthcare MedicareDirect Rx (PFFS) medicare insurance offers a $0.90 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $10.50 for 75% low-income subsidy $20.10 for 50% and $29.80 for 25%.


Full Assistance Premium:$0.90
75% Assistance Premium:$10.50
50% Assistance Premium:$20.10
25% Assistance Premium:$29.80


Formulary and 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.

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%

The complete UnitedHealthcare MedicareDirect Rx (PFFS) Formulary.
*Initial Coverage Phase and 30 day supply





2023 Summary of Benefits


The benefit information provided is a summary of what UnitedHealthcare MedicareDirect Rx (PFFS) 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.

Wellness programs (e.g., fitness, nursing hotline)Covered



Contact lenses


VisionNot covered



Eyeglass frames


VisionNot covered



Eyeglass lenses


VisionNot covered



Eyeglasses (frames and lenses)


VisionNot covered



Other


VisionNot covered



Routine eye exam


Vision$0 copay



Upgrades


VisionNot covered




TransportationNot covered
Skilled Nursing Facility$0 per day for days 1 through 20
$196 per day for days 21 through 55
$0 per day for days 56 through 100



Occupational therapy visit


Rehabilitation services$40 copay



Physical therapy and speech and language therapy visit


Rehabilitation services$40 copay



Cleaning


Preventive dentalNot covered



Dental x-ray(s)


Preventive dentalNot covered



Fluoride treatment


Preventive dentalNot covered



Oral exam


Preventive dentalNot covered




Preventive care$0 copay
Outpatient hospital coverage$0-395 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


Mental health services$395 per day for days 1 through 4
$0 per day for days 5 through 90



Outpatient group therapy visit


Mental health services$15 copay



Outpatient group therapy visit with a psychiatrist


Mental health services$15 copay



Outpatient individual therapy visit


Mental health services$25 copay



Outpatient individual therapy visit with a psychiatrist


Mental health services$25 copay



Chemotherapy


Medicare Part B drugs20% coinsurance



Other Part B drugs


Medicare Part B drugs0-20% coinsurance



Diabetes supplies


Medical equipment/supplies$0 copay per item



Durable medical equipment (e.g., wheelchairs, oxygen)


Medical equipment/supplies20% coinsurance per item



Prosthetics (e.g., braces, artificial limbs)


Medical equipment/supplies20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$6,700
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



Fitting/evaluation


HearingNot covered



Hearing aids - inner ear


HearingNot covered



Hearing aids - outer ear


HearingNot covered



Hearing aids - over the ear


HearingNot covered



Hearing exam


Hearing$20 copay




Health plan deductible$0
Ground ambulance$250 copay



Foot exams and treatment


Foot care (podiatry services)$50 copay



Routine foot care


Foot care (podiatry services)$50 copay



Emergency


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



Urgent care


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



Primary


Doctor visits$25 copay per visit



Specialist


Doctor visits$50 copay per visit



Diagnostic radiology services (e.g., MRI)


Diagnostic procedures/lab services/imaging$0-160 copay



Diagnostic tests and procedures


Diagnostic procedures/lab services/imaging$25 copay



Lab services


Diagnostic procedures/lab services/imaging$0 copay



Outpatient x-rays


Diagnostic procedures/lab services/imaging$15 copay



Diagnostic services


Comprehensive dentalNot covered



Endodontics


Comprehensive dentalNot covered



Extractions


Comprehensive dentalNot covered



Non-routine services


Comprehensive dentalNot covered



Periodontics


Comprehensive dentalNot covered



Prosthodontics, other oral/maxillofacial surgery, other services


Comprehensive dentalNot covered



Restorative services


Comprehensive dentalNot covered




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




UnitedHealthcare MedicareDirect Rx (PFFS) Reviews


Is UnitedHealthcare MedicareDirect Rx (PFFS) a good plan? UnitedHealthcare MedicareDirect Rx (PFFS) received a 3 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 UnitedHealthcare MedicareDirect Rx Reviews 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 H5435-024 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 UnitedHealthcare MedicareDirect Rx (PFFS) requires you to live in that plan’s service area. The service area is listed below:



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How much does UnitedHealthcare MedicareDirect Rx (PFFS) cost?

UnitedHealthcare charges a $92.00 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is UnitedHealthcare MedicareDirect Rx (PFFS) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. UnitedHealthcare MedicareDirect Rx (PFFS) by UnitedHealthcare MOOP is $-. Once you spend $- you will pay nothing for Part A or Part B covered services.

What type of plan is UnitedHealthcare MedicareDirect Rx (PFFS)?

UnitedHealthcare MedicareDirect Rx (PFFS) is a PFFS. A Private Fee-For-Service (PFFS) is a plan offered by a contract with the (CMS) to provide you with benefits. PFFS plans are the most flexible but your doctor will make a visit-by-visit decisions on whether to accept your provider.

Is UnitedHealthcare MedicareDirect Rx (PFFS) a good plan?

UnitedHealthcare MedicareDirect Rx (PFFS) received a 3 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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