AARP Medicare Advantage Headwaters (PPO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by UnitedHealthcare
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
No Rating
out of 5 stars

State: North Dakota

Select your county to view the price for this plan

 


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

 

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

Medical Benefits

Doctor Services

In-network: $20 per visit
Out-of-network: $20 per visit
In-network: $50 per visit
Out-of-network: $50 per visit

Tests, labs, & imaging

In-network: $20
Out-of-network: $20
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0-140
Out-of-network: $0-140
In-network: $14
Out-of-network: $14
$90 per visit (always covered)
$30-40 per visit (always covered)

Hospital Services

In-network: $450 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: $450 per day for days 1 through 4
$0 per day for days 5 and beyond
In-network: $0-450 per visit
Out-of-network: $0-450 per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$160 per day for days 21 through 62
$0 per day for days 63 through 100
Out-of-network: $150 per day for days 1 through 16
$250 per day for days 17 through 34
$0 per day for days 35 through 100

Preventive services

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

Ambulance

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

Therapy services

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

Mental health services

In-network: $20
Out-of-network: $20
In-network: $20
Out-of-network: $20
In-network: $20
Out-of-network: $20
In-network: $20
Out-of-network: $20

Opioid treatment services

Covered

Other services

In-network: 20% per item
Out-of-network: 50% per item
In-network: 20% per item
Out-of-network: 20% per item
In-network: $0 per item
Out-of-network: 20% per item

Prescription Drug Benefits

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

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


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 copay or 5% (whichever costs more)

Generic$14.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier25%

Part B Drugs

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

Extra Benefits

Hearing

In-network: $0 copay
Out-of-network: $50
Not covered
In-network: $375-2,075
Out-of-network: $375

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

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

Vision

In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: 50%
In-network: $0 copay
Out-of-network: 50%
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Not covered
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating
No Rating

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