UnitedHealthcare Dual Complete (HMO)
UnitedHealthcare
Medicare Advantage Plan (with drug coverage)
Special Needs Plan: Dual Eligible
Special Needs Plan: Dual Eligible
Plan ID: H0169-003-0 | Stanton County, NE | 2021
Medicare Plan Overall Rating
UnitedHealthcare Dual Complete Drug Coverage and Costs in Stanton County, NE
| UnitedHealthcare Dual Complete (Dual Eligible SNP) |
|
|---|---|
| Drug Coverage |  |
| Plan Type | HMO |
| Total Monthly Premium | $0.00 |
| Health Plan Premium | $0.00 |
| Drug Plan Premium | $0.00 |
| Standard Part B Premium | $148.50 |
| Max You Pay for Health Services (in-network) | $7,550.00 |
| Part D Deductible | $445.00 |
| Select Plan |
Doctors, Specialists, Tests, Labs, Imaging
| UnitedHealthcare Dual Complete (Dual Eligible SNP) |
|
|---|---|
| Primary Doctor Visit | $0 copay |
| Specialist Visit | $0 copay |
| Diagnostic Tests & Procedures | $0 copay |
| Lab Services | $0 copay |
| Diagnostic Radiology Services (like MRI) | $0 copay |
| Outpatient X-rays | $0 copay |
Hospitals, Skilled Nursing, Urgent Care
| UnitedHealthcare Dual Complete (Dual Eligible SNP) |
|
|---|---|
| Emergency Care | $0 copay |
| Urgent Care | $0 copay |
| Ambulance (Ground) | $0 copay |
| Inpatient Hospital Coverage | $0 copay |
| Outpatient Hospital Coverage | $0 copay |
| Skilled Nursing Facility Stays | $0 copay |
| Preventive Services | $0 copay |
Hearing and Vision
| UnitedHealthcare Dual Complete (Dual Eligible SNP) |
|
|---|---|
| Hearing Exam | $0 copay |
| Hearing Fitting / Evaluation | Not covered |
| Hearing Aides - All Types | $0 copay |
| Routine Eye Exam | $0 copay |
| Contact Lenses | $0 copay |
| Eyeglasses (Frames & Lenses) | Not covered |
| Eyeglass Frames (only) | $0 copay |
| Eyeglass Lenses (only) | $0 copay |
| Upgrades (vision) | Not covered |
Physical, Occupational, Speech Therapy and Mental Health
| UnitedHealthcare Dual Complete (Dual Eligible SNP) |
|
|---|---|
| Occupational Therapy Visit | $0 copay |
| Physical Therapy Visit | $0 copay |
| Speech Pathology Visit | $0 copay |
| Outpatient Group Therapy with a Psychiatrist | $0 copay |
| Outpatient Individual Therapy with a Psychiatrist | $0 copay |
| Outpatient Group Therapy Visit | $0 copay |
| Outpatient Individual Therapy Visit | $0 copay |
Dental Coverage
| UnitedHealthcare Dual Complete (Dual Eligible SNP) |
|
|---|---|
| Oral Exam | $0 copay |
| Oral Cleaning | $0 copay |
| Flouride Treatment | $0 copay |
| Dental X-rays | $0 copay |
| Non-routine Services | $0 copay |
| Diagnostic Services | $0 copay |
| Restorative Services | $0 copay |
| Endodontics | $0 copay |
| Periodontics | $0 copay |
| Extractions | $0 copay |
| Prosthodontics, Other Oral / Maxillofacial Surgery, Other Services | $0 copay |
Medical Equipment, Dialysis, Diabetes
| UnitedHealthcare Dual Complete (Dual Eligible SNP) |
|
|---|---|
| Durable medical equipment (like wheelchairs & oxygen) | $0 copay |
| Prosthetics (like braces, artificial limbs) | $0 copay |
| Diabetes Supplies | $0 copay |
Drug Coverage and Costs (Initial Coverage Phase)
| UnitedHealthcare Dual Complete (Dual Eligible SNP) |
|---|
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 OF THE MIDWEST, INC. UnitedHealthcare |
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| Summary Rating of Health Plan Quality |
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| Staying Healthy: Screenings, Tests, & Vaccines |
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| Breast cancer screening |
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| Colorectal cancer screening |
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| Yearly flu vaccine |
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| Improving or maintaining physical health | Not Available | |||
| Improving or maintaining mental health | Not Available | |||
| Monitoring physical activity |
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| Checking to see if members are at a healthy weight |
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| Managing Chronic (Long-term) Conditions |
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| Members whose plan did an assessment of their health needs and risks |
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| Yearly review of all medications and supplements being taken |
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| Yearly assessment of how well plan members are able to do activities of daily living |
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| Yearly pain screening or pain management plan |
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| Osteoporosis management | Not Available | |||
| Eye exam to check for damage from diabetes |
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| Kidney function testing for members with diabetes |
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| Plan members with diabetes whose blood sugar is under control |
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| Rheumatoid arthritis management |
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| Reducing the risk of falling |
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| Improving bladder control | Not Available | |||
| The plan makes sure member medication records are up-to-date after hospital discharge |
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| The plan makes sure members with heart disease get the most effective drugs to treat high cholesterol | Not Available | |||
| Member Experience with Health Plan |
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| Ease of getting needed care and seeing specialists |
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| Getting appointments and care quickly |
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| Health plan provides information or help when members need it |
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| Member's rating of health care quality |
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| Member's rating of health plan |
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| Coordination of members' health care services |
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| Member Complaints & Changes in the Health Plan's Performance |
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| Complaints about the health plan (more stars are better because it means fewer complaints) |
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| Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) |
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| Improvement (if any) in the health plan's performance | Not Available | |||
| Health Plan Customer Service |
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| Health plan makes timely decisions about appeals |
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| Fairness of the health plan's appeal decisions, based on an independent reviewer |
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| Availability of TTY services and foreign language interpretation when prospective members call the health plan |
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| Drug Plan (Part D) Star Rating |
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| Drug Plan Customer Service |
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| Availability of TTY services and foreign language interpretation when prospective members call the drug plan |
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| Drug plan fails to make timely decisions about appeals (more stars are better because it means fewer delays) |
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| Fairness of drug plan's appeal decisions, based on an independent reviewer | Not Available | |||
| Member Complaints & Changes in the Drug Plan's Performance |
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| Complaints about the drug plan (more stars are better because it means fewer complaints) |
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| Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) |
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| Improvement (if any) in the drug plan's performance |
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| Member Experience with the Drug Plan |
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| Members' rating of drug plan |
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| Ease of getting prescriptions filled when using the plan |
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| Drug Safety & Accuracy of Drug Pricing |
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| Plan provides accurate drug pricing information for Medicare's website |
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| Taking diabetes medication as directed |
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| Taking blood pressure medication as directed |
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| Taking cholesterol medication as directed |
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| Members who had a pharmacist (or other health professional) help them understand and manage their medications |
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| The plan makes sure members with diabetes take the most effective drugs to treat high cholesterol |
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Last Updated: September 19, 2021
