UnitedHealthcare MedicareDirect Patriot (PFFS)

UnitedHealthcare

Medicare Advantage Plan (without drug coverage)

Plan ID: H5435-001-0 | Box Butte County, NE | 2021

Medicare Plan Overall Rating

UnitedHealthcare MedicareDirect Patriot Drug Coverage and Costs in Box Butte County, NE

	UnitedHealthcare MedicareDirect Patriot	UnitedHealthcare MedicareDirect Rx
Drug Coverage
Plan Type	PFFS	PFFS
Total Monthly Premium	$40.00	$64.00
Health Plan Premium	$40.00	$36.80
Drug Plan Premium		$27.20
Standard Part B Premium	$148.50	$148.50
Max You Pay for Health Services (in-network)	$6,700.00	$6,700.00
Part D Deductible		$295.00
	Select Plan

Doctors, Specialists, Tests, Labs, Imaging

	UnitedHealthcare MedicareDirect Patriot	UnitedHealthcare MedicareDirect Rx
Primary Doctor Visit	$25 copay per visit	$25 copay per visit
Specialist Visit	$50 copay per visit	$50 copay per visit
Diagnostic Tests & Procedures	$25 copay	$25 copay
Lab Services	$0 copay	$0 copay
Diagnostic Radiology Services (like MRI)	$0-150 copay	$0-160 copay
Outpatient X-rays	$15 copay	$15 copay

Hospitals, Skilled Nursing, Urgent Care

	UnitedHealthcare MedicareDirect Patriot	UnitedHealthcare MedicareDirect Rx
Emergency Care	$90 copay per visit (always covered)	$90 copay per visit (always covered)
Urgent Care	$40 copay per visit (always covered)	$40 copay per visit (always covered)
Ambulance (Ground)	$250 copay	$250 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	$395 per day for days 1 through 4 $0 per day for days 5 through 90 $0 per day for days 91 and beyond
Outpatient Hospital Coverage	$0-395 copay per visit	$0-395 copay per visit
Skilled Nursing Facility Stays	$0 per day for days 1 through 20 $184 per day for days 21 through 57 $0 per day for days 58 through 100	$0 per day for days 1 through 20 $184 per day for days 21 through 57 $0 per day for days 58 through 100
Preventive Services	$0 copay	$0 copay

Hearing and Vision

	UnitedHealthcare MedicareDirect Patriot	UnitedHealthcare MedicareDirect Rx
Hearing Exam	$20 copay	$20 copay
Hearing Fitting / Evaluation	Not covered	Not covered
Hearing Aides - All Types
Routine Eye Exam	$0 copay	$0 copay
Contact Lenses	Not covered	Not covered
Eyeglasses (Frames & Lenses)	Not covered	Not covered
Eyeglass Frames (only)	Not covered	Not covered
Eyeglass Lenses (only)	Not covered	Not covered
Upgrades (vision)	Not covered	Not covered

Physical, Occupational, Speech Therapy and Mental Health

	UnitedHealthcare MedicareDirect Patriot	UnitedHealthcare MedicareDirect Rx
Occupational Therapy Visit	$40 copay	$40 copay
Physical Therapy Visit	$40 copay	$40 copay
Speech Pathology Visit	$40 copay	$40 copay
Outpatient Group Therapy with a Psychiatrist	$15 copay	$15 copay
Outpatient Individual Therapy with a Psychiatrist	$25 copay	$25 copay
Outpatient Group Therapy Visit	$15 copay	$15 copay
Outpatient Individual Therapy Visit	$25 copay	$25 copay

Dental Coverage

	UnitedHealthcare MedicareDirect Patriot	UnitedHealthcare MedicareDirect Rx
Oral Exam	Not covered	Not covered
Oral Cleaning	Not covered	Not covered
Flouride Treatment	Not covered	Not covered
Dental X-rays	Not covered	Not covered
Non-routine Services	Not covered	Not covered
Diagnostic Services	Not covered	Not covered
Restorative Services	Not covered	Not covered
Endodontics	Not covered	Not covered
Periodontics	Not covered	Not covered
Extractions	Not covered	Not covered
Prosthodontics, Other Oral / Maxillofacial Surgery, Other Services	Not covered	Not covered

Medical Equipment, Dialysis, Diabetes

	UnitedHealthcare MedicareDirect Patriot	UnitedHealthcare MedicareDirect Rx
Durable medical equipment (like wheelchairs & oxygen)	20% coinsurance per item	20% coinsurance per item
Prosthetics (like braces, artificial limbs)	20% coinsurance per item	20% coinsurance per item
Diabetes Supplies	$0 copay per item	$0 copay per item

Drug Coverage and Costs (Initial Coverage Phase)

	UnitedHealthcare MedicareDirect Patriot	UnitedHealthcare MedicareDirect Rx
	This plan does not include drug coverage. Please select another plan to compare Part D drug coverage.

Important Plan Information

Plan limits may apply for the above services - There may be limits on how much the plan will provide.

Advanced Plan Approval May be Required for the above services - A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the enrollee is not responsible for obtaining (prior) authorization.

Physician Referral May be Required - A process through which the enrollee’s primary care physician or other network physician (depending on the plan policy) permits or instructs the enrollee to obtain an item or service from another physician or other provider type.

FOR INFORMATIONAL PURPOSES ONLY

The plans listed on this page are for informational purposes only. SeniorFax has no plan affiliations and does not endorse any plans displayed. The information provided is based on publicly available data from the Centers for Medicare & Medicaid Services (CMS). Current data is accessible on medicare.gov. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Actual plan costs and coverage can vary. Always consult a licensed insurance agent before purchasing insurance products.

Medicare Star Rating Performance

UNITEDHEALTHCARE INSURANCE COMPANY UnitedHealthcare
Summary Rating of Health Plan Quality
Staying Healthy: Screenings, Tests, & Vaccines
Breast cancer screening
Colorectal cancer screening
Yearly flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical activity
Checking to see if members are at a healthy weight
Managing Chronic (Long-term) Conditions
Members whose plan did an assessment of their health needs and risks			Not Available
Yearly review of all medications and supplements being taken			Not Available
Yearly assessment of how well plan members are able to do activities of daily living			Not Available
Yearly pain screening or pain management plan			Not Available
Osteoporosis management
Eye exam to check for damage from diabetes
Kidney function testing for members with diabetes
Plan members with diabetes whose blood sugar is under control
Rheumatoid arthritis management
Reducing the risk of falling
Improving bladder control
The plan makes sure member medication records are up-to-date after hospital discharge
The plan makes sure members with heart disease get the most effective drugs to treat high cholesterol
Member Experience with Health Plan
Ease of getting needed care and seeing specialists
Getting appointments and care quickly
Health plan provides information or help when members need it
Member's rating of health care quality
Member's rating of health plan
Coordination of members' health care services
Member Complaints & Changes in the Health Plan's Performance
Complaints about the health plan (more stars are better because it means fewer complaints)
Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan)
Improvement (if any) in the health plan's performance
Health Plan Customer Service
Health plan makes timely decisions about appeals
Fairness of the health plan's appeal decisions, based on an independent reviewer
Availability of TTY services and foreign language interpretation when prospective members call the health plan
Drug Plan (Part D) Star Rating
Drug Plan Customer Service
Availability of TTY services and foreign language interpretation when prospective members call the drug plan
Drug plan fails to make timely decisions about appeals (more stars are better because it means fewer delays)
Fairness of drug plan's appeal decisions, based on an independent reviewer			Not Available
Member Complaints & Changes in the Drug Plan's Performance
Complaints about the drug plan (more stars are better because it means fewer complaints)
Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan)
Improvement (if any) in the drug plan's performance
Member Experience with the Drug Plan
Members' rating of drug plan
Ease of getting prescriptions filled when using the plan
Drug Safety & Accuracy of Drug Pricing
Plan provides accurate drug pricing information for Medicare's website
Taking diabetes medication as directed
Taking blood pressure medication as directed
Taking cholesterol medication as directed
Members who had a pharmacist (or other health professional) help them understand and manage their medications
The plan makes sure members with diabetes take the most effective drugs to treat high cholesterol