UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
Medicare Plan Details (2023 Plan)
Monthly Premium
by UnitedHealthcare
Additional Coverage
Overall Government Star Rating
3.5Ready to Enroll Online?
Plan Type
Medicare Advantage (Part C) with Prescription Drug (Part D)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D
Plan Details
$6,700 In-network
Medical Benefits
Doctor Services
Out-of-network: $25-45 copay per visit
Out-of-network: $45 copay per visit
Tests, labs, & imaging
Out-of-network: $20 copay
Out-of-network: $0 copay
Out-of-network: $0-130 copay
Out-of-network: $15 copay
Hospital Services
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: $335 per day for days 1 through 5
$0 per day for days 6 and beyond
Out-of-network: $0-335 copay per visit
Skilled nursing facility
$196 per day for days 21 through 55
$0 per day for days 56 through 100
Out-of-network: $225 per day for days 1 through 30
$0 per day for days 31 through 100
Preventive services
Out-of-network: $0 copay
Ambulance
Out-of-network: $250 copay
Therapy services
Out-of-network: $40 copay
Out-of-network: $40 copay
Mental health services
Out-of-network: $15-25 copay
Out-of-network: $15-25 copay
Out-of-network: $15-25 copay
Out-of-network: $15-25 copay
Opioid treatment services
Other services
Out-of-network: $55 copay or 50% coinsurance per item
Out-of-network: $55 copay or 50% coinsurance per item
Out-of-network: $55 copay or 50% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $4.00 copay | $4.00 copay |
Brand-name drugs :
|
| Generic | $15.00 copay | $15.00 copay | |
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | $100.00 copay | ||
| Specialty Tier | 33% | ||
| 1 * The above cost-sharing only applies to some drugs on this tier. For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. | |||
Part B Drugs
Out-of-network: 0-20% coinsurance
Out-of-network: 0-20% coinsurance
Extra Benefits
Hearing
Out-of-network: $45 copay
Out-of-network: $175-1,225 copay
Preventive Dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Vision
Out-of-network: $20 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Other benefits
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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