UnitedHealthcare Medicare Advantage Patriot (Regional PPO)

Medicare Plan Details

2021 Plan

Monthly Premium

(select county for price)

by UnitedHealthcare

Additional Coverage

Hearing Vision Dental

Overall Government Star Rating

3.5

out of 5 stars

State: Georgia

Select your county to view the price for this plan

Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

Monthly Premium

Health Portion of Premium

Drug Portion of Premium

Health Plan Deductible

Health Plan Max Out-of-Pocket

$6,700 In and Out-of-network
$6,700 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

http://www.UHCMedicareSolutions.com

Plan Link

http://www.UHCMedicareSolutions.com

Medical Benefits

Doctor Services

Primary doctor visit

In-network: $0 copay
Out-of-network: $0 copay

Specialist visit

In-network: $45 copay per visit
Out-of-network: $45 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $25 copay
Out-of-network: $0-100 copay

Lab services

In-network: $0 copay
Out-of-network: $0 copay

Diagnostic radiology services (like MRI)

In-network: $0-100 copay
Out-of-network: $0-100 copay

Outpatient x-rays

In-network: $15 copay
Out-of-network: $15 copay

Emergency care

$90 copay per visit (always covered)

Urgent care

$30-40 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: $395 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
Out-of-network: $395 per day for days 1 through 4
$0 per day for days 5 and beyond

Outpatient hospital coverage

In-network: $0-335 copay per visit
Out-of-network: $0-335 copay per visit

Skilled nursing facility

In-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
Out-of-network: $225 per day for days 1 through 30
$0 per day for days 31 through 100

Preventive services

In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance

In-network: $250 copay
Out-of-network: $250 copay

Therapy services

Occupational therapy visit

In-network: $40 copay
Out-of-network: $40 copay

Physical therapy & speech & language therapy visit

In-network: $40 copay
Out-of-network: $40 copay

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $15 copay
Out-of-network: $15-25 copay

Outpatient individual therapy with a psychiatrist

In-network: $25 copay
Out-of-network: $15-25 copay

Outpatient group therapy visit

In-network: $15 copay
Out-of-network: $15-25 copay

Outpatient individual therapy visit

In-network: $25 copay
Out-of-network: $15-25 copay

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 20% coinsurance per item
Out-of-network: 50% coinsurance per item

Prosthetics (like braces, artificial limbs)

In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item

Diabetes supplies

In-network: $0 copay
Out-of-network: 20% coinsurance per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

Chemotherapy drugs

In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Other Part B drugs

In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Extra Benefits

Hearing

Hearing exam

In-network: $0 copay
Out-of-network: $45 copay

Fitting/evaluation

Not covered

Hearing aids - All types

In-network: $375-2,075 copay
Out-of-network: $375 copay

Preventive Dental

Oral exam

In-network: $0 copay
Out-of-network: $0 copay

Cleaning

In-network: $0 copay
Out-of-network: $0 copay

Fluoride treatment

In-network: $0 copay
Out-of-network: $0 copay

Dental x-rays

In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Non-routine services

Not covered

Diagnostic services

In-network: $0 copay
Out-of-network: $0 copay

Restorative services

In-network: $0 copay
Out-of-network: $0 copay

Endodontics

Not covered

Periodontics

Not covered

Extractions

Not covered

Prosthodontics, other oral/maxillofacial surgery, other services

In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam

In-network: $0 copay
Out-of-network: $0 copay

Contact lenses

In-network: $0 copay
Out-of-network: $0 copay

Eyeglasses (frames & lenses)

In-network: $0 copay
Out-of-network: $0 copay

Eyeglass frames (only)

Not covered

Eyeglass lenses (only)

Not covered

Upgrades

Not covered

Other benefits

Fitness benefit

Limited coverage

Over the counter drug benefits

Not covered

In-home support services

Not covered

Home and bathroom safety devices

Not covered

Meals for short duration

Not covered

Annual physical exams

Limited coverage

Telehealth

Limited coverage

Summary rating of health plan quality

3.5

Staying healthy: screenings, tests, & vaccines

Managing chronic (long term) conditions

Member experience with health plan

Member complaints & changes in the health plan's performance

Health plan customer service

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