Providers, members are responsible for any copay, coinsurance or deductible, according to their benefit plan. Most UnitedHealthcare Medicare Advantage plans have $0 copays for covered telehealth services. If you enroll in a UnitedHealthcare Medicare Advantage plan, you can receive a wide range of preventive services for a $0 copay when you visit your primary care provider. Some of these covered preventive services include: Alcohol misuse screening and counseling Bone mass measurement (for those at.
- Unitedhealthcare Medicare Advantage Plans
- Unitedhealthcare Medicare Advantage Copays Providers
- No Copay Medicare Advantage Plans
- Is Unitedhealthcare Medicare Advantage
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UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) H6528-006 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by UnitedHealthcare available to residents in Georgia. This plan includes additional Medicare prescription drug (Part-D) coverage. The UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out of pocket. This can be a extremely nice safety net.
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
UnitedHealthcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) 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 Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from UnitedHealthcare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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2021 UnitedHealthcare Medicare Advantage Plan Costs
| Name: | UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) |
|---|---|
| Plan ID: | |
| Provider: | UnitedHealthcare |
| Year: | 2021 |
| Type: | Local PPO |
| Monthly Premium C+D: | $0 |
| Part C Premium: | $0 |
| MOOP: | $6,700 |
| Part D (Drug) Premium: | $0 |
| Part D Supplemental Premium | $0 |
| Total Part D Premium: | $0 |
| Drug Deductible: | $275.0 |
| 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: | H6528-031 |
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) Part-C Premium
UnitedHealthcare plan charges a $0 Part-C 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.
H6528-006 Part-D Deductible and Premium
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) has a monthly drug premium of $0 and a $275.0 drug deductible. This UnitedHealthcare plan offers a $0 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 $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
UnitedHealthcare Gap Coverage
In 2021 once you and your plan provider have spent $4130 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.
H6528-006 Formulary or Drug Coverage
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) 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.
2021 UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) Summary of Benefits
Additional Benefits
| No |
|---|
Comprehensive Dental
| Diagnostic services | 0-50% coinsurance (Out-of-Network) |
|---|---|
| Diagnostic services | $0 copay |
| Endodontics | 0-50% coinsurance (Out-of-Network) |
| Endodontics | $0 copay |
| Extractions | 50% coinsurance |
| Extractions | 0-50% coinsurance (Out-of-Network) |
| Non-routine services | 0-50% coinsurance (Out-of-Network) |
| Non-routine services | 50% coinsurance |
| Periodontics | 0-50% coinsurance (Out-of-Network) |
| Periodontics | 50% coinsurance |
| Prosthodontics, other oral/maxillofacial surgery, other services | 0-50% coinsurance |
| Prosthodontics, other oral/maxillofacial surgery, other services | 0-50% coinsurance (Out-of-Network) |
| Restorative services | 0-50% coinsurance |
| Restorative services | 0-50% coinsurance (Out-of-Network) |
Deductible
| $0 |
|---|
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $0-110 copay |
|---|---|
| Diagnostic radiology services (e.g., MRI) | $150-200 copay (Out-of-Network) |
| Diagnostic tests and procedures | $20 copay |
| Diagnostic tests and procedures | $40 copay (Out-of-Network) |
| Lab services | $0 copay (Out-of-Network) |
| Lab services | $0 copay |
| Outpatient x-rays | $20 copay (Out-of-Network) |
| Outpatient x-rays | $15 copay |
Doctor Visits
| Primary | $10 copay per visit |
|---|---|
| Primary | $30-60 copay per visit (Out-of-Network) |
| Specialist | $60 copay per visit (Out-of-Network) |
| Specialist | $40 copay per visit |
Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
|---|---|
| Urgent care | $30-40 copay per visit (always covered) |
Foot Care (podiatry services)
| Foot exams and treatment | $40 copay |
|---|---|
| Foot exams and treatment | $60 copay (Out-of-Network) |
| Routine foot care | $40 copay |
| Routine foot care | $60 copay (Out-of-Network) |
Ground Ambulance
| $250 copay (Out-of-Network) |
|---|
| $250 copay |
Hearing
| Fitting/evaluation | Not covered |
|---|---|
| Hearing aids | $375-2,075 copay |
| Hearing aids | $375 copay (Out-of-Network) |
| Hearing exam | $0 copay |
| Hearing exam | $60 copay (Out-of-Network) |
Inpatient Hospital Coverage
| $295 per day for days 1 through 7 $0 per day for days 8 through 90 $0 per day for days 91 and beyond |
|---|
| $495 per day for days 1 through 10 $0 per day for days 11 and beyond (Out-of-Network) |
Medical Equipment/Supplies
| Diabetes supplies | $0 copay per item |
|---|---|
| Diabetes supplies | 40% coinsurance per item (Out-of-Network) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20-50% coinsurance per item (Out-of-Network) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs) | 40% coinsurance per item (Out-of-Network) |
Medicare Part B Drugs
| Chemotherapy | 40% coinsurance (Out-of-Network) |
|---|---|
| Chemotherapy | 20% coinsurance |
| Other Part B drugs | 40% coinsurance (Out-of-Network) |
| Other Part B drugs | 20% coinsurance |
Mental Health Services
| Inpatient hospital - psychiatric | $495 per day for days 1 through 10 $0 per day for days 11 through 90 (Out-of-Network) |
|---|---|
| Inpatient hospital - psychiatric | $295 per day for days 1 through 5 $0 per day for days 6 through 90 |
| Outpatient group therapy visit | $30-40 copay (Out-of-Network) |
| Outpatient group therapy visit | $15 copay |
| Outpatient group therapy visit with a psychiatrist | $15 copay |
| Outpatient group therapy visit with a psychiatrist | $30-40 copay (Out-of-Network) |
| Outpatient individual therapy visit | $25 copay |
| Outpatient individual therapy visit | $30-40 copay (Out-of-Network) |
| Outpatient individual therapy visit with a psychiatrist | $30-40 copay (Out-of-Network) |
| Outpatient individual therapy visit with a psychiatrist | $25 copay |
MOOP
| $10,000 In and Out-of-network $6,700 In-network |
|---|
Option
| No |
|---|
Optional supplemental benefits
| No |
|---|
Outpatient Hospital Coverage
| $0-295 copay per visit |
|---|
| $495 copay per visit (Out-of-Network) |
Preventive Care
| $0 copay (Out-of-Network) |
|---|
| $0 copay |
Preventive Dental
| Cleaning | $0 copay |
|---|---|
| Cleaning | $0 copay (Out-of-Network) |
| Dental x-ray(s) | $0 copay |
| Dental x-ray(s) | $0 copay (Out-of-Network) |
| Fluoride treatment | $0 copay (Out-of-Network) |
| Fluoride treatment | $0 copay |
| Oral exam | $0 copay |
| Oral exam | $0 copay (Out-of-Network) |
Rehabilitation Services
| Occupational therapy visit | $60 copay (Out-of-Network) |
|---|---|
| Occupational therapy visit | $40 copay |
| Physical therapy and speech and language therapy visit | $60 copay (Out-of-Network) |
| Physical therapy and speech and language therapy visit | $40 copay |
Skilled Nursing Facility
| $225 per day for days 1 through 45 $0 per day for days 46 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 |
Transportation
| Not covered |
|---|
Vision
| Contact lenses | $0 copay (Out-of-Network) |
|---|---|
| Contact lenses | $0 copay |
| Eyeglass frames | Not covered |
| Eyeglass lenses | Not covered |
| Eyeglasses (frames and lenses) | $0 copay |
| Eyeglasses (frames and lenses) | $0 copay (Out-of-Network) |
| Other | Not covered |
| Routine eye exam | $0 copay |
| Routine eye exam | $60 copay (Out-of-Network) |
| Upgrades | Not covered |
Wellness Programs (e.g. fitness nursing hotline)
| Covered |
|---|
Reviews for UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) H6528
| 2019 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 |
| Improving Physical |
| Improving Mental Health |
| Monitoring Physical Activity |
| Adult BMI Assessment |
Managing Chronic And Long Term Care for Older Adults
| Total Rating |
|---|
| SNP Care Management |
| Medication Review |
| Functional Status Assessment |
| Pain Screening |
| Osteoporosis Management |
| Diabetes Care - Eye Exam |
| Diabetes Care - Kidney Disease |
| Diabetes Care - Blood Sugar |
| Rheumatoid Arthritis |
| Reducing Risk of Falling |
| Improving Bladder Control |
| Medication Reconciliation |
| Statin Therapy |
Member Experience with Health Plan
| Total Experience Rating |
|---|
| Getting Needed Care |
| Customer Service |
| Health Care Quality |
| Rating of Health Plan |
| Care Coordination |
Member Complaints and Changes in UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) Plans Performance
| Total Rating |
|---|
| Complaints about Health Plan |
| Members Leaving the Plan |
| Health Plan Quality Improvement |
| Timely Decisions About Appeals |
Health Plan Customer Service Rating for UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO)
| Total Customer Service Rating |
|---|
| Reviewing Appeals Decisions |
| Call Center, TTY, Foreign Language |
UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO) Drug Plan Customer Service Ratings
| Total Rating |
|---|
| Call Center, TTY, Foreign Language |
| Appeals Auto |
| Appeals Upheld |
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 |
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO)
Unitedhealthcare Medicare Advantage Plans
(Click county to compare all available Advantage plans)
| State: | Georgia |
|---|---|
| County: | Baldwin,Banks,Barrow,Ben Hill,Bibb, Bryan,Bulloch,Chatham,Cherokee, Clarke,Clayton,Columbia,Coweta, Crawford,Crisp,Dawson,Dodge, Dooly,Douglas,Effingham,Emanuel, Evans,Fayette,Forsyth,Gwinnett, Habersham,Hall,Harris,Henry, Houston,Irwin,Jackson,Johnson, Laurens,Lumpkin,Macon,Montgomery, Muscogee,Newton,Oconee,Paulding, Peach,Pulaski,Richmond,Rockdale, Spalding,Stephens,Taylor,Telfair, Tift,Toombs,Towns,Treutlen, Turner,Twiggs,Union,Upson, Walton,White,Wilcox,Wilkinson, |
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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, 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 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
At a glance
- $0 premium plans available in some areas
- Many plans offer prescription drug coverage and vision and dental benefits
- 4.9 million people are enrolled in a UnitedHealthcare Medicare Advantage Plan1
UnitedHealthcare offers Medicare Advantage plans that combine the benefits offered by Medicare Part A and Part B (also called Original Medicare) into one simple plan.
Many Medicare Advantage plans (also called Medicare Part C) offer additional benefits that Medicare Part A and Part B don’t cover.
These additional benefits can include:
- Coverage for prescription drugs
- Vision care
- Hearing care
- Fitness and wellness programs
According to the Kaiser Family Foundation, 25 percent of all Medicare Advantage plan beneficiaries in 2018 were members of a Medicare Advantage plan from UnitedHealthcare.2 |
What Do UnitedHealthcare Medicare Advantage Plans Cover?
Not all UnitedHealthcare Medicare Advantage plans are available in all locations, and plan programs and service availability can vary by plan and service area.
If you enroll in a UnitedHealthcare Medicare Advantage plan, you can receive a wide range of preventive services for a $0 copay when you visit your primary care provider.
Some of these covered preventive services include:
- Alcohol misuse screening and counseling
- Bone mass measurement (for those at high risk)
- Mammograms
- Cardiovascular screening
- Hepatitis B immunization and Hepatitis C screening
- Colorectal cancer screening
- Diabetes screening
- Pneumococcal shot
- Prostate-specific antigen (POSA) test
- Counseling to stop smoking
- Flu shots
These are just a few of the preventive services covered by your UnitedHealthcare Medicare Advantage plan.
Depending on your plan and location, you may also have access to:
- Disease management programs
- Health management programs
- Alternative care services
- Fitness program
- Seasonal flu shot information
- NurseLinesm
UnitedHealthcare Offers Several Types of Medicare Advantage Plans
UnitedHealthcare offers several different types of Medicare Advantage plans. These plans include, but aren’t limited to:
- MedicareComplete (HMO)
- MedicareComplete Access (HMO)
- MedicareComplete Choice (PPO)
- MedicareComplete Focus (HMO)
- MedicareComplete Focus (PPO)
- MedicareComplete SecureHorizons (HMO)
- MedicareComplete Value (HMO)
- MedicareComplete Plus Plan 1 (HMO-POS)
- MedicareComplete Plus Plan 2 (HMO-POS)
Not all plans are available in all areas, and you can reach out to a licensed insurance agent to find out more about the plans available where you live by calling 1-855-580-18541-855-580-1854TTY Users: 71124 hours a day, 7 days a week.
Health Maintenance Organization (HMO)
A UnitedHealthcare Medicare HMO plan features a network of local health care providers who work to coordinate your care. You typically are required to get medical services from providers within your plan network, except for in cases of urgent care, emergency care or renal dialysis that is out of your plan network.
An HMO plan may also require you to get a referral before seeing a specialist, depending on your plan.
Point-of-Service (POS)
A UnitedHealthcare Medicare POS plan is similar to an HMO, but it offers you the flexibility to visit health care providers for certain services outside of the plan’s network. In most cases, your out-of-pocket costs for medical care will be higher if you see a provider outside of the plan network.
Unitedhealthcare Medicare Advantage Copays Providers
A POS plan may also require you to get a referral before seeing a specialist, depending on your plan.
Preferred Provider Organization (PPO)
With a UnitedHealthcare Medicare PPO plan, you can see providers in and out of your plan network for all services that are covered by the plan. If you see a provider outside of the plan network, your out-of-pocket costs will typically be higher.
A PPO plan does not require you to get a referral before seeing a specialist.
UnitedHealthcare Offers Several Types of Medicare Special Needs Plans
Medicare Special Needs Plans (SNP) are special Medicare Advantage plans that can offer some additional benefits to help support an eligible beneficiary’s specific health or budget needs.
With each type of Medicare SNP plan from UnitedHealthcare, you are generally required to receive care and medical services from providers in your plan network. Some plans allow you to receive out-of-network care, but it may come with higher out-of-pocket costs.
UnitedHealthcare offers several different types of Medicare SNP plans:
- Dual Eligible Plans
- Institutional Plans
- Institutional-Equivalent Plans
- Chronic Condition Plans
Not all plans are available in all areas.
Dual Eligible Plans
These plans are intended for people who get both Medicare and Medicaid.
Institutional Plans
These plans are intended for Medicare beneficiaries who live in skilled nursing facilities.
Institutional-Equivalent Plans
These plans are intended for Medicare beneficiaries who live in assisted living communities and who need the same types of care as people who live in skilled nursing facilities.
Chronic Condition Plans
These plans are intended for Medicare beneficiaries who have certain severe or disabling chronic conditions.
No Copay Medicare Advantage Plans
Enrolling in a UnitedHealthcare Medicare Advantage Plan
UnitedHealthcare Medicare Advantage plans can give you a way to receive all of your health care coverage under one comprehensive plan.
Learn more about UnitedHealthcare Medicare Advantage plan options and find plans that may be available in your area. Call 1-855-580-18541-855-580-1854TTY Users: 711 24 hours a day, 7 days a week to speak with a licensed insurance agent and to find a Medicare plan from UnitedHealthcare that may be right for you.
Is Unitedhealthcare Medicare Advantage
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