AARP Medicare Advantage Choice (PPO)

UnitedHealthcare
Medicare Advantage Plan (with drug coverage)
Plan ID: H1278-001-0 | Stanton County, NE | 2021
Rating Not Available
Medicare Plan Overall Rating
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AARP Medicare Advantage Choice Drug Coverage and Costs in Stanton County, NE

AARP Medicare Advantage Choice AARP Medicare Advantage Patriot
Drug Coverage Drug Coverage included in plan Drug Coverage excluded in plan
Plan Type PPO PPO
Total Monthly Premium $19.00 $0.00
Health Plan Premium $0.00 $0.00
Drug Plan Premium $19.00 This plan does not include Drug Coverage
Standard Part B Premium $148.50 $148.50
Max You Pay for Health Services (in-network) $3,900.00 $6,700.00
Part D Deductible $0.00 This plan does not include Drug Coverage
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Doctors, Specialists, Tests, Labs, Imaging

AARP Medicare Advantage Choice AARP Medicare Advantage Patriot
Primary Doctor Visit $0 copay
(in-network)

$15-50 copay per visit
(out-of-network)
$10 copay per visit
(in-network)

$25-60 copay per visit
(out-of-network)
Specialist Visit $35 copay per visit
(in-network)

$50 copay per visit
(out-of-network)
$45 copay per visit
(in-network)

$60 copay per visit
(out-of-network)
Diagnostic Tests & Procedures $30 copay
(in-network)

$0-110 copay
(out-of-network)
$30 copay
(in-network)

$0-110 copay
(out-of-network)
Lab Services $0 copay
(in-network)

$0 copay
(out-of-network)
$0 copay
(in-network)

$0 copay
(out-of-network)
Diagnostic Radiology Services (like MRI) $0-110 copay
(in-network)

$0-110 copay
(out-of-network)
$0-110 copay
(in-network)

$0-110 copay
(out-of-network)
Outpatient X-rays $15 copay
(in-network)

$15 copay
(out-of-network)
$15 copay
(in-network)

$15-20 copay
(out-of-network)

Hospitals, Skilled Nursing, Urgent Care

AARP Medicare Advantage Choice AARP Medicare Advantage Patriot
Emergency Care $90 copay per visit (always covered) $90 copay per visit (always covered)
Urgent Care $30-40 copay per visit (always covered) $30-40 copay per visit (always covered)
Ambulance (Ground) $250 copay
(in-network)

$250 copay
(out-of-network)
$250 copay
(in-network)

$250 copay
(out-of-network)
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
(in-network)

$395 per day for days 1 through 4
$0 per day for days 5 and beyond
(out-of-network)
$295 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
(in-network)

$295 per day for days 1 through 6
$0 per day for days 7 and beyond
(out-of-network)
Outpatient Hospital Coverage $0-395 copay per visit
(in-network)

$0-395 copay per visit
(out-of-network)
$0-295 copay per visit
(in-network)

$0-295 copay per visit
(out-of-network)
Skilled Nursing Facility Stays $0 per day for days 1 through 20
$184 per day for days 21 through 42
$0 per day for days 43 through 100
(in-network)

$150 per day for days 1 through 16
$250 per day for days 17 through 22
$0 per day for days 23 through 100
(out-of-network)
$0 per day for days 1 through 20
$184 per day for days 21 through 57
$0 per day for days 58 through 100
(in-network)

$150 per day for days 1 through 16
$250 per day for days 17 through 34
$0 per day for days 35 through 100
(out-of-network)
Preventive Services $0 copay
(in-network)

$0 copay
(out-of-network)
$0 copay
(in-network)

$0 copay
(out-of-network)

Hearing and Vision

AARP Medicare Advantage Choice AARP Medicare Advantage Patriot
Hearing Exam $0 copay
(in-network)

$50 copay
(out-of-network)
$0 copay
(in-network)

$60 copay
(out-of-network)
Hearing Fitting / Evaluation Not covered Not covered
Hearing Aides - All Types $375-2,075 copay
(in-network)

$375 copay
(out-of-network)
$375-2,075 copay
(in-network)

$375 copay
(out-of-network)
Routine Eye Exam $0 copay
(in-network)

$0 copay
(out-of-network)
$0 copay
(in-network)

$0 copay
(out-of-network)
Contact Lenses $0 copay
(in-network)

$0 copay
(out-of-network)
$0 copay
(in-network)

$0 copay
(out-of-network)
Eyeglasses (Frames & Lenses) $0 copay
(in-network)

$0 copay
(out-of-network)
$0 copay
(in-network)

$0 copay
(out-of-network)
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

AARP Medicare Advantage Choice AARP Medicare Advantage Patriot
Occupational Therapy Visit $35 copay
(in-network)

$35 copay
(out-of-network)
$40 copay
(in-network)

$40 copay
(out-of-network)
Physical Therapy Visit $35 copay
(in-network)

$35 copay
(out-of-network)
$40 copay
(in-network)

$40 copay
(out-of-network)
Speech Pathology Visit $35 copay
(in-network)

$35 copay
(out-of-network)
$40 copay
(in-network)

$40 copay
(out-of-network)
Outpatient Group Therapy with a Psychiatrist $0 copay
(in-network)

$15 copay
(out-of-network)
$10 copay
(in-network)

$25 copay
(out-of-network)
Outpatient Individual Therapy with a Psychiatrist $0 copay
(in-network)

$15 copay
(out-of-network)
$10 copay
(in-network)

$25 copay
(out-of-network)
Outpatient Group Therapy Visit $0 copay
(in-network)

$15 copay
(out-of-network)
$10 copay
(in-network)

$25 copay
(out-of-network)
Outpatient Individual Therapy Visit $0 copay
(in-network)

$15 copay
(out-of-network)
$10 copay
(in-network)

$25 copay
(out-of-network)

Dental Coverage

AARP Medicare Advantage Choice AARP Medicare Advantage Patriot
Oral Exam $0 copay
(in-network)

$0 copay
(out-of-network)
$0 copay
(in-network)

$0 copay
(out-of-network)
Oral Cleaning $0 copay
(in-network)

$0 copay
(out-of-network)
$0 copay
(in-network)

$0 copay
(out-of-network)
Flouride Treatment $0 copay
(in-network)

$0 copay
(out-of-network)
$0 copay
(in-network)

$0 copay
(out-of-network)
Dental X-rays $0 copay
(in-network)

$0 copay
(out-of-network)
$0 copay
(in-network)

$0 copay
(out-of-network)
Non-routine Services 50% coinsurance
(in-network)

0-50% coinsurance
(out-of-network)
50% coinsurance
(in-network)

0-50% coinsurance
(out-of-network)
Diagnostic Services $0 copay
(in-network)

0-50% coinsurance
(out-of-network)
$0 copay
(in-network)

0-50% coinsurance
(out-of-network)
Restorative Services 0-50% coinsurance
(in-network)

0-50% coinsurance
(out-of-network)
0-50% coinsurance
(in-network)

0-50% coinsurance
(out-of-network)
Endodontics $0 copay
(in-network)

0-50% coinsurance
(out-of-network)
$0 copay
(in-network)

0-50% coinsurance
(out-of-network)
Periodontics 50% coinsurance
(in-network)

0-50% coinsurance
(out-of-network)
50% coinsurance
(in-network)

0-50% coinsurance
(out-of-network)
Extractions 50% coinsurance
(in-network)

0-50% coinsurance
(out-of-network)
50% coinsurance
(in-network)

0-50% coinsurance
(out-of-network)
Prosthodontics, Other Oral / Maxillofacial Surgery, Other Services 0-50% coinsurance
(in-network)

0-50% coinsurance
(out-of-network)
0-50% coinsurance
(in-network)

0-50% coinsurance
(out-of-network)

Medical Equipment, Dialysis, Diabetes

AARP Medicare Advantage Choice AARP Medicare Advantage Patriot
Durable medical equipment (like wheelchairs & oxygen) 20% coinsurance per item
(in-network)

$55 copay or 50% coinsurance per item
(out-of-network)
20% coinsurance per item
(in-network)

$55 copay or 50% coinsurance per item
(out-of-network)
Prosthetics (like braces, artificial limbs) 20% coinsurance per item
(in-network)

20% coinsurance per item
(out-of-network)
20% coinsurance per item
(in-network)

20% coinsurance per item
(out-of-network)
Diabetes Supplies $0 copay per item
(in-network)

20% coinsurance per item
(out-of-network)
$0 copay per item
(in-network)

20% coinsurance per item
(out-of-network)

Drug Coverage and Costs (Initial Coverage Phase)

AARP Medicare Advantage Choice AARP Medicare Advantage Patriot
Standard Retail Pharmacy (1 month supply)
Preferred Generic $4.00 copay This plan does not include Drug Coverage
Generic $14.00 copay This plan does not include Drug Coverage
Preferred Brand $47.00 copay This plan does not include Drug Coverage
Non-Preferred Brand $100.00 copay This plan does not include Drug Coverage
Specialty Tier 33% This plan does not include Drug Coverage
Preferred Mail Order Pharmacy (3 month supply)
Preferred Generic $0.00 copay This plan does not include Drug Coverage
Generic $0.00 copay This plan does not include Drug Coverage
Preferred Brand $131.00 copay This plan does not include Drug Coverage
Non-Preferred Brand $290.00 copay This plan does not include Drug Coverage
Standard Mail Order Pharmacy (3 month supply)
Preferred Generic $12.00 copay This plan does not include Drug Coverage
Generic $42.00 copay This plan does not include Drug Coverage
Preferred Brand $141.00 copay This plan does not include Drug Coverage
Non-Preferred Brand $300.00 copay This plan does not include 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 enrolleeā€™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

HARKEN HEALTH INSURANCE COMPANY
UnitedHealthcare
Medicare Rating Not Available
Summary Rating of Health Plan Quality Not Available
Staying Healthy: Screenings, Tests, & Vaccines Not Available
Breast cancer screening Not Available
Colorectal cancer screening Not Available
Yearly flu vaccine Not Available
Improving or maintaining physical health Not Available
Improving or maintaining mental health Not Available
Monitoring physical activity Not Available
Checking to see if members are at a healthy weight Not Available
Managing Chronic (Long-term) Conditions Not Available
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 Not Available
Eye exam to check for damage from diabetes Not Available
Kidney function testing for members with diabetes Not Available
Plan members with diabetes whose blood sugar is under control Not Available
Rheumatoid arthritis management Not Available
Reducing the risk of falling Not Available
Improving bladder control Not Available
The plan makes sure member medication records are up-to-date after hospital discharge Not Available
The plan makes sure members with heart disease get the most effective drugs to treat high cholesterol Not Available
Member Experience with Health Plan Not Available
Ease of getting needed care and seeing specialists Not Available
Getting appointments and care quickly Not Available
Health plan provides information or help when members need it Not Available
Member's rating of health care quality Not Available
Member's rating of health plan Not Available
Coordination of members' health care services Not Available
Member Complaints & Changes in the Health Plan's Performance 5/5 stars
Complaints about the health plan (more stars are better because it means fewer complaints) 5/5 stars
Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) 4/5 stars
Improvement (if any) in the health plan's performance Not Available
Health Plan Customer Service 5/5 stars
Health plan makes timely decisions about appeals 5/5 stars
Fairness of the health plan's appeal decisions, based on an independent reviewer 5/5 stars
Availability of TTY services and foreign language interpretation when prospective members call the health plan 5/5 stars
Drug Plan (Part D) Star Rating 3.5/5 stars
Drug Plan Customer Service 5/5 stars
Availability of TTY services and foreign language interpretation when prospective members call the drug plan 5/5 stars
Drug plan fails to make timely decisions about appeals (more stars are better because it means fewer delays) 5/5 stars
Fairness of drug plan's appeal decisions, based on an independent reviewer Not Available
Member Complaints & Changes in the Drug Plan's Performance 5/5 stars
Complaints about the drug plan (more stars are better because it means fewer complaints) 5/5 stars
Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) 4/5 stars
Improvement (if any) in the drug plan's performance Not Available
Member Experience with the Drug Plan Not Available
Members' rating of drug plan Not Available
Ease of getting prescriptions filled when using the plan Not Available
Drug Safety & Accuracy of Drug Pricing 3/5 stars
Plan provides accurate drug pricing information for Medicare's website 5/5 stars
Taking diabetes medication as directed 3/5 stars
Taking blood pressure medication as directed 3/5 stars
Taking cholesterol medication as directed 3/5 stars
Members who had a pharmacist (or other health professional) help them understand and manage their medications 4/5 stars
The plan makes sure members with diabetes take the most effective drugs to treat high cholesterol 2/5 stars
Last Updated: September 19, 2021

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