AARP MedicareComplete Choice Essential (Regional PPO)

Medicare Advantage Plan (Part C)

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PARTC

Plan Summary

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

What To Know About This Plan

  • This is a health coverage only plan with no drug coverage
  • This plan is available for 2015. see plan

Why We Like This Plan

  • 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:
2014
Optional Supplemental Benefits?
No
Choice of Doctors?
Any Doctor
Prescription Drugs Covered?
No
Out-Of-Pocket Spending Limit
$6,700 In-Network$10,000 In and Out-of-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
Not Applicable
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Inpatient Hospital Care
Days 1-4: $395 copay per day. Days 5-90: $0 copay per day
40%
Inpatient Mental Health Care
Days 1-3: $395 copay per day. Days 4-90: $0 copay per day
40%
Skilled Nursing Facility (SNF)
Days 1-20: $25 copay per day. Days 21-61: $152 copay per day. Days 62-100: $0 copay per day
Days 1-52: $195 copay per SNF day. Days 53-100: $0 copay per SNF day
Home Health Care
$0 maximum per visit
50% maximum per visit
Doctor Office Visits
$10 maximum per visit
$40 maximum per visit
Outpatient Services
$16 maximum or 20% maximum per visit
$21 maximum or 40% maximum per visit
Ambulance Services
$300 maximum
$300 maximum
Emergency Care
$65 maximum per visit
Not Applicable
Durable Medical Equipment
20% maximum per item
50% maximum per item
Kidney Disease and Conditions
20% maximum per visit
20% maximum per visit
Specialist Office Visit
$50 maximum per visit
$70 maximum per visit

Prescription Drug Coverage

Drugs Covered under Medicare Part B

General

Most drugs not covered.

20% of the cost for Medicare Part B chemotherapy drugs and other Part B drugs.

50% of the cost for Medicare Part B drugs out-of-network.


Drugs Covered under Medicare Part D

General

This plan does not offer prescription drug coverage.


Optional Supplemental Benefits

Other Services

Inpatient Care

Doctor and Hospital Choice



In-Network

No referral required for network doctors, specialists, and hospitals.

In and Out-of-Network

You can go to doctors, specialists, and hospitals in or out of the network. It will cost more to get out of network benefits.

Out of Service Area

Plan covers you when you travel in the U.S. or its territories.


,

Inpatient Hospital Care



In-Network

No limit to the number of days covered by the plan each hospital stay.

For Medicare-covered hospital stays:

  • Days 1 - 4: $395 copay per day


  • Days 5 - 90: $0 copay per day


$0 copay for each additional non-Medicare-covered hospital day.

Out-of-Network

40% of the cost for each Medicare-covered hospital stay.


Outpatient Care

Inpatient Mental Health Care



In-Network

You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.

For Medicare-covered hospital stays:

  • Days 1 - 3: $395 copay per day


  • Days 4 - 90: $0 copay per day


Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day.

Out-of-Network

40% of the cost for each Medicare-covered hospital stay.


,

Skilled Nursing Facility (SNF)



In-Network

Plan covers up to 100 days each benefit period

No prior hospital stay is required.

For Medicare-covered SNF stays:

  • Days 1 - 20: $25 copay per day


  • Days 21 - 61: $152 copay per day


  • Days 62 - 100: $0 copay per day


Out-of-Network

For each Medicare-covered SNF stay:

  • Days 1 - 52: $195 copay per SNF day


  • Days 53 - 100: $0 copay per SNF day



,

Home Health Care



In-Network

$0 copay for each Medicare-covered home health visit

Out-of-Network

50% of the cost for Medicare-covered home health visits


,

Hospice



General

You must get care from a Medicare-certified hospice. You must consult with your plan before you select hospice.


,

Doctor Office Visits



In-Network

$10 copay for each Medicare-covered primary care doctor visit.

$50 copay for each Medicare-covered specialist visit.

Out-of-Network

$70 copay for each Medicare-covered specialist visit

$40 copay for each Medicare-covered primary care doctor visit


Outpatient Medical Services and Supplies

Chiropractic Services



In-Network

$20 copay for each Medicare-covered chiropractic visit

Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part).

Out-of-Network

$70 copay for Medicare-covered chiropractic visits.


,

Podiatry Services



In-Network

$50 copay for each Medicare-covered podiatry visit

$50 copay for up to 6 supplemental routine podiatry visit(s) every year

Medicare-covered podiatry visits are for medically necessary foot care.

Out-of-Network

$70 copay for Medicare-covered podiatry visits

$70 copay for supplemental routine podiatry visits


,

Outpatient Mental Health Care



In-Network

$40 copay for each Medicare-covered individual therapy visit

$30 copay for each Medicare-covered group therapy visit

$40 copay for each Medicare-covered individual therapy visit with a psychiatrist

$30 copay for each Medicare-covered group therapy visit with a psychiatrist

$55 copay for Medicare-covered partial hospitalization program services

Out-of-Network

$75 copay for Medicare-covered partial hospitalization program services

$35 to $45 copay for Medicare-covered Mental Health visits with a psychiatrist

$35 to $45 copay for Medicare-covered Mental Health visits


,

Outpatient Substance Abuse Care



In-Network

$40 copay for Medicare-covered individual substance abuse outpatient treatment visits

$30 copay for Medicare-covered group substance abuse outpatient treatment visits

Out-of-Network

$35 to $45 copay for Medicare-covered substance abuse outpatient treatment visits


,

Outpatient Services



In-Network

20% of the cost for each Medicare-covered ambulatory surgical center visit

$13 to $16 copay [or 20% of the cost] for each Medicare-covered outpatient hospital facility visit

Out-of-Network

40% of the cost for Medicare-covered ambulatory surgical center visits

$13 to $21 copay [or 40% of the cost] for Medicare-covered outpatient hospital facility visits


,

Ambulance Services



In-Network

$300 copay for Medicare-covered ambulance benefits.

Out-of-Network

$300 copay for Medicare-covered ambulance benefits.


,

Emergency Care



General

$65 copay for Medicare-covered emergency room visits

Worldwide coverage.

If you are admitted to the hospital within 24-hour(s) for the same condition, you pay $0 for the emergency room visit.


,

Urgently Needed Care



General

$30 to $40 copay for Medicare-covered urgently-needed-care visits


,

Outpatient Rehabilitation Services



General

Medically necessary physical therapy, occupational therapy, and speech and language pathology services are covered.

In-Network

$50 copay for Medicare-covered Occupational Therapy visits

$50 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits

Out-of-Network

$70 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits

$70 copay for Medicare-covered Occupational Therapy visits.


,

Durable Medical Equipment



In-Network

20% of the cost for Medicare-covered durable medical equipment

Out-of-Network

50% of the cost for Medicare-covered durable medical equipment


Preventive Services

Prosthetic Devices



In-Network

20% of the cost for Medicare-covered prosthetic devices

20% of the cost for Medicare-covered medical supplies related to prosthetics, splints, and other devices

Out-of-Network

40% of the cost for Medicare-covered prosthetic devices.


,

Diabetes Programs and Supplies



In-Network

$0 copay for Medicare-covered Diabetes self-management training

$0 copay for Medicare-covered Diabetes monitoring supplies

20% of the cost for Medicare-covered Therapeutic shoes or inserts

Out-of-Network

40% of the cost for Medicare-covered Diabetes self-management training

40% of the cost for Medicare-covered Diabetes monitoring supplies

40% of the cost for Medicare-covered Therapeutic shoes or inserts


,

Diagnostic Tests, X-Rays, Lab Services, and Radiology Services



In-Network

$13 copay for Medicare-covered lab services

20% of the cost for Medicare-covered diagnostic procedures and tests

$16 copay for Medicare-covered X-rays

20% of the cost for Medicare-covered diagnostic radiology services (not including X-rays)

20% of the cost for Medicare-covered therapeutic radiology services

If the doctor provides you services in addition to Outpatient Diagnostic Procedures, Tests and Lab Services, separate cost sharing of $10 to $50 may apply

If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services, separate cost sharing of $10 to $50 may apply

Out-of-Network

$13 to $21 copay [or 40% of the cost] for Medicare-covered therapeutic radiology services

$13 to $21 copay [or 40% of the cost] for Medicare-covered outpatient X-rays

$13 to $21 copay [or 40% of the cost] for Medicare-covered diagnostic radiology services

$13 to $21 copay [or 40% of the cost] for Medicare-covered diagnostic procedures and tests

$13 to $21 copay [or 40% of the cost] for Medicare-covered lab services

If the doctor provides you services in addition to (Medicarecovered Diagnostic Procedures/Tests, Medicarecovered Laboratory Services, Diagnostic Radiological Services, Therapeutic Radiological Services, Outpatient X-Rays ), separate cost sharing of $40 to $70 may apply


,

Cardiac and Pulmonary Rehabilitation Services



In-Network

$50 copay for Medicare-covered Cardiac Rehabilitation Services

$50 copay for Medicare-covered Intensive Cardiac Rehabilitation Services

$50 copay for Medicare-covered Pulmonary Rehabilitation Services

Out-of-Network

$70 copay for Medicare-covered Cardiac Rehabilitation Services

$70 copay for Medicare-covered Intensive Cardiac Rehabilitation Services

$70 copay for Medicare-covered Pulmonary Rehabilitation Services


Additional Benefits

Preventive Services



General

$0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.

In-Network

$0 copay for a supplemental annual physical exam

Out-of-Network

40% of the cost for a supplemental annual physical exam

0% to 40% of the cost for Medicare-covered preventive services


,

Kidney Disease and Conditions



In-Network

20% of the cost for Medicare-covered renal dialysis

$0 copay for Medicare-covered kidney disease education services

Out-of-Network

40% of the cost for Medicare-covered kidney disease education services

20% of the cost for Medicare-covered renal dialysis


,

Dental Services



In-Network

In general, preventive dental benefits (such as cleaning) not covered.

$50 copay for Medicare-covered dental benefits

Out-of-Network

$70 copay for Medicare-covered comprehensive dental benefits


,

Hearing Services



In-Network

$50 copay for Medicare-covered diagnostic hearing exams

$10 copay for up to 1 supplemental routine hearing exam(s) every year

$380 copay each for up to 2 supplemental inner-ear hearing aid(s) every year

$330 copay each for up to 2 supplemental over-the-ear hearing aid(s) every year

Out-of-Network

$70 copay for Medicare-covered diagnostic hearing exams.

$70 copay for supplemental hearing exams.

$330 to $380 copay for supplemental hearing aids.


,

Vision Services



In-Network

$0 to $50 copay for Medicare-covered exams to diagnose and treat diseases and conditions of the eye, including an annual glaucoma screening for people at risk

$50 copay for up to 1 supplemental routine eye exam(s) every year

$0 copay for one pair of Medicare-covered eyeglasses (lenses and frames) or contact lenses after cataract surgery.

Out-of-Network

$70 copay for Medicare-covered eye exams

$70 copay for supplemental routine eye exams

40% of the cost for Medicare-covered eyewear


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 Essential (Regional PPO) for Florida

/
COHEN, SHELDON
9000 SW 137TH AVE
MIAMI, FL 33186
MEZEY, ROBERT
12600 SW 120TH ST
MIAMI, FL 33186
GENAO, ESTEBAN
13059 SW 112TH ST
MIAMI, FL 33186
ROJAS, ROMEO
12002 SW 128TH CT STE 204
MIAMI, FL 33186
JIMENEZ, MILTON
12002 SW 128TH CT STE 204
MIAMI, FL 33186
GOUGH-FIBKINS, SHAWN
9824 SW 133RD CT
MIAMI, FL 33186
RENE N MAYORGA M D P A
14261 SW 120TH ST
MIAMI, FL 33186
CEBALLOS, CESAR
7800 SW 87TH AVE
MIAMI, FL 33173
NUNEZ, LOURDES
12002 SW 128TH CT
MIAMI, FL 33186
HERRERA, MAURICIO
11801 SW 90TH ST
MIAMI, FL 33186
GALICIA, EDGAR
10010 KENNERLY RD
SAINT LOUIS, MO 63128
TAYLOR, MARTIN
8501 SW 124TH AVE
MIAMI, FL 33183
RIOS, JUANA
8900 SW 117TH AVE
MIAMI, FL 33186
PANDO, JARY
13001 SW 88TH ST
MIAMI, FL 33186
MARTINEZ-RAMOS, MARIA
9000 SW 137 AVE
MIAMI, FL 33186
ZAMBRANA, NOREEN
14687 SW 104TH ST
MIAMI, FL 33186
HERNANDEZ, OSCAR
14221 SW 120TH ST
MIAMI, FL 33186
SCHNEIDER, JESSICA
12608 SW 88TH ST
MIAMI, FL 33186
GARCIA-ORTIZ, SANDRA
11435 SW 133RD CT APT 3
MIAMI, FL 33186
VALDES-RAFULS, JACQUELINE
8000 SW 117TH AVE
MIAMI, FL 33183
MIRO, ADELAIDA
12720 SW 70TH LN
MIAMI, FL 33183
FANILLA, EDUARDO
6963 SW 117TH AVE
MIAMI, FL 33183
PINERA-LLANO, AYLEEN
8501 SW 124TH AVE
MIAMI, FL 33183
MORALES, PEDRO
8200 SW 117TH AVE STE 110
MIAMI, FL 33183
WATSON, EDWARD
6660 SW 117TH AVE
MIAMI, FL 33183
Details
SHELDON COHEN, M.D.
Phone Number
(305) 380-6773
Office Locations
9000 SW 137TH AVE
MIAMI, FL 33186
9000 SW 137TH AVE MIAMI FL, 33186

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.
1 question| 1 answer
my doctor is not contracted to uhc what do i pay
Q:
Asked by Anonymous 

1 answer

Know the Answer? Answer this Question
A: HealthPocket is an source of information and not a health plan or an insurance agent. For your specific benefits inquiry, it is best to speak with a licensed agent. The phone number and hours of operation is available when you click on 'Select'.
Answered on 2/8/2014 by davina

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