UnitedHealthcare Medicare Advantage Open Essential (PPO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by UnitedHealthcare
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 4.0
out of 5 stars

State: Wisconsin

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

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

Tests, labs, & imaging

In-network: $25
Out-of-network: $0-100
In-network: $10
Out-of-network: $10-14
In-network: $0-100
Out-of-network: $0-100
In-network: $14
Out-of-network: $10-14
$90 per visit (always covered)
$30-40 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: $0-250 per visit
Out-of-network: $0-250 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: $0 per day for days 1 through 20
$160 per day for days 21 through 62
$0 per day for days 63 through 100

Preventive services

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

Ambulance

In-network: $250
Out-of-network: $0-250

Therapy services

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

Mental health services

In-network: $0 copay
Out-of-network: $0-5
In-network: $5
Out-of-network: $0-5
In-network: $0 copay
Out-of-network: $0-5
In-network: $5
Out-of-network: $0-5

Opioid treatment services

Covered

Other services

In-network: 20% per item
Out-of-network: 45% 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

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: $45
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

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

Vision

In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $55 or 50%
In-network: $0 copay
Out-of-network: $55 or 50%
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
 4
 4
 4
 4
 4
 5

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