UnitedHealthcare Medicare Gold (Regional PPO C-SNP)

Medicare Plan Details (2023 Plan)


Monthly Premium

 

by UnitedHealthcare
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 3.5
out of 5 stars

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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

 

$19
$2
$17
$0
$6,700 In and Out-of-network
$6,700 In-network
No
Yes
Yes
Yes

Doctor Services

In-network: $0 copay
Out-of-network: $25-45 copay per visit
In-network: $45 copay per visit
Out-of-network: $45 copay per visit

Tests, labs, & imaging

In-network: $20 copay
Out-of-network: $20 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0-130 copay
Out-of-network: $0-130 copay
In-network: $15 copay
Out-of-network: $15 copay
$90 copay per visit (always covered)
$40 copay per visit (always covered)

Hospital Services

In-network: $335 per day for days 1 through 5
$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
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
$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

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

Ambulance

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

Therapy services

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

Mental health services

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

Opioid treatment services

Covered

Other services

In-network: 20% coinsurance per item
Out-of-network: $55 copay or 50% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: $55 copay or 50% coinsurance per item
In-network: $0 copay
Out-of-network: $55 copay or 50% coinsurance per item

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

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$4.00 copay$4.00 copay


Generic drugs :
$4.15 copay or 5% (whichever costs more)

Brand-name drugs :
$10.35 copay or 5% (whichever costs more)

Generic$15.00 copay$15.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%
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

In-network: 20% coinsurance
Out-of-network: 0-20% coinsurance
In-network: 0-20% coinsurance
Out-of-network: 0-20% coinsurance

Hearing

In-network: $0 copay
Out-of-network: $45 copay
Not covered
In-network: $175-1,225 copay
Out-of-network: $175-1,225 copay

Preventive Dental

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

Comprehensive dental

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

Vision

In-network: $0 copay
Out-of-network: $20 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Not covered
Not covered
Not covered

Other benefits

Not covered
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
 3.5
 3
 4
 4
 3
 5
 3
 5
 3
 3
 3

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