UnitedHealthcare Medicare Advantage Assure (PPO)


Medicare Plan Details

2021 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: Utah

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

 

$33
$0
$33
$198 annual deductible
$10,000 In and Out-of-network
$7,550 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $0 copay
Out-of-network: 30% coinsurance per visit
In-network: 20% coinsurance per visit
Out-of-network: 30% coinsurance per visit

Tests, labs, & imaging

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

Hospital Services

In-network: $1,400 per stay
$0 per day for days 91 and beyond
Out-of-network: 30% per stay
In-network: 0-20% coinsurance per visit
Out-of-network: 30% coinsurance 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% coinsurance

Ambulance

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

Therapy services

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

Mental health services

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

Opioid treatment services

Covered

Other services

In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
In-network: $0 copay per item
Out-of-network: 30% coinsurance 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 :
$3.70 copay or 5% (whichever costs more)

Brand-name drugs :
$9.20 copay or 5% (whichever costs more)

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

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

Extra Benefits

Hearing

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

Limited coverage
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
No Rating
No Rating
No Rating
No Rating
 5
 5
 4.5
 5
 5
No Rating
 4

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