UnitedHealthcare Medicare Advantage Assure (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: New Hampshire

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

 

$23
$0
$23
$0
$10,000 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: 30% per visit
In-network: 20% per visit
Out-of-network: 30% per visit

Tests, labs, & imaging

In-network: 20%
Out-of-network: 30%
In-network: $0
Out-of-network: $0 copay
In-network: 20%
Out-of-network: 30%
In-network: 20%
Out-of-network: 30%
$90 per visit (always covered)
$65 per visit (always covered)

Hospital Services

In-network: $1,300 per stay
Out-of-network: 30% per stay
In-network: 0-20% per visit
Out-of-network: 30% per visit

Skilled nursing facility

In-network: Coming soon
Out-of-network: 30% per stay

Preventive services

In-network: $0 copay
Out-of-network: 0-30%

Ambulance

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

Therapy services

In-network: 20%
Out-of-network: 30%
In-network: 20%
Out-of-network: 30%

Mental health services

In-network: 20%
Out-of-network: 30%
In-network: 20%
Out-of-network: 30%
In-network: 20%
Out-of-network: 30%
In-network: 20%
Out-of-network: 30%

Opioid treatment services

Covered

Other services

In-network: 20% per item
Out-of-network: 30% per item
In-network: 20% per item
Out-of-network: 30% per item
In-network: $0 per item
Out-of-network: 30% 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


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
Preferred Brand
Non-Preferred Drug
Specialty Tier

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: 30%
Not covered
In-network: $0 copay
Out-of-network: $0 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
Out-of-network: $0 copay
Not covered
In-network: $0
Out-of-network: $0 copay
In-network: $0
Out-of-network: $0 copay
In-network: $0
Out-of-network: $0 copay
In-network: $0
Out-of-network: $0 copay
In-network: $0
Out-of-network: $0 copay

Vision

In-network: $0
Out-of-network: 30%
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
Limited coverage
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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