AARP MedicareComplete Choice (PPO)

Medicare Advantage Plan (Part C w/ RX)

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PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
UnitedHealthcare
CMS Rating
Plan Type
PPO
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage
  • This plan is available for 2015. see plan

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium
  • gives you freedom to choose which doctors, specialist and hospitals you visit
  • Primary care physician office visit copay of $10

Plan Details

Costs and Other Important Information

Plan Year:
2013
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Any Doctor
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,900 In-Network$6,200 In and Out-of-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$10 maximum per visit
$25 maximum per visit
Specialist Office Visit
$35 maximum per visit
$45 maximum per visit
Outpatient Services
20% maximum per visit
40% maximum per visit
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$200 maximum
$200 maximum
Kidney Disease and Conditions
20% maximum per visit
20% maximum per visit
Home Health Care
$0 maximum per visit
50% maximum per visit
Durable Medical Equipment
20% maximum per item
50% maximum per item
Inpatient Hospital Care
Days 1-7: $220 copay per day. Days 8-90: $0 copay per day
Days 1-17: $375 copay per day. Days 18 and beyond: $0 copay per day
Skilled Nursing Facility (SNF)
Days 1-20: $50 copay per day. Days 21-40: $150 copay per day. Days 41-100: $0 copay per day
Days 1-32: $195 copay per SNF day. Days 33-100: $0 copay per SNF day
Inpatient Mental Health Care
Days 1-6: $220 copay per day. Days 7-90: $0 copay per day
Days 1-17: $375 copay per day. Days 18-90: $0 copay per day

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$3 copay$3 copayNot offered
Tier 2: Non-Preferred Generic$6 copay$6 copayNot offered
Tier 3: Preferred Brand Name$45 copay$45 copayNot offered
Tier 4: Non-Preferred Brand Name$95 copay$95 copayNot offered
Tier 5: Specialty Tier33% coinsurance33% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$9 copay$9 copay$6 copay
Tier 2: Non-Preferred Generic$18 copay$18 copay$12 copay
Tier 3: Preferred Brand Name$135 copay$135 copay$125 copay
Tier 4: Non-Preferred Brand Name$285 copay$285 copay$275 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Cholesterol screening for patients with heart disease
Glaucoma testing
Annual flu vaccine
Pneumonia vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Improving bladder control
Reducing the risk of falling
Plan all-cause readmissions

Ratings of Plan Responsiveness and Care

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan

Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

Complaints about the health plan
Beneficiary access and performance problems
Members choosing to leave the plan
Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability

Physician Finder

Physicians that accept AARP MedicareComplete Choice (PPO) for New Mexico

/
DOZEMAN, LYNN
6900 GONZALES RD SW
ALBUQUERQUE, NM 87121
PIERCE, JENNIFER
2401 GILLHAM RD
KANSAS CITY, MO 64108
HAWKES, ELIZABETH
2001 EL CENTRO FAMILIAR BLVD SW
ALBUQUERQUE, NM 87105
BIRD, MARTHA
1101 MEDICAL ARTS AVE NE
ALBUQUERQUE, NM 87102
GUTTMAN, JOHN
200 RIO BRAVO BLVD SE
ALBUQUERQUE, NM 87105
FU, REBEKAH
3436 ISLETA BLVD SW
ALBUQUERQUE, NM 87105
MURPHY, SUSAN
PMG ISLETA
ALBUQUERQUE, NM 87105
TOMAN, ELIZABETH
1760 GRANDE BLVD SE
RIO RANCHO, NM 87124
ZANGHELLINI, FELIPE
2001 N CENTRO FAMILIAR SW
ALBUQUERQUE, NM 87105
LEWIS, SUSAN
5400 GIBSON BLVD SE
ALBUQUERQUE, NM 87108
Details
LYNN DOZEMAN, MD
Phone Number
(505) 831-2534
Office Locations
6900 GONZALES RD SW
ALBUQUERQUE, NM 87121
6900 GONZALES RD SW ALBUQUERQUE NM, 87121

Community Q&A

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