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

Plan Details

Costs and Other Important Information

Plan Year:
2014
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Any Doctor
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,975 In-Network$9,375 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
$5 maximum per visit
$25 maximum per visit
Specialist Office Visit
$35 maximum per visit
$45 maximum per visit
Outpatient Services
20% maximum per visit
30% 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: $250 copay per day. Days 8-90: $0 copay per day
30%
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
30%
Inpatient Mental Health Care
Days 1-5: $250 copay per day. Days 6-90: $0 copay per day
30%

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$4 copay$4 copayNot offered
Tier 2: Non-Preferred Generic$8 copay$8 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$12 copay$12 copay$8 copay
Tier 2: Non-Preferred Generic$24 copay$24 copay$16 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
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
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 Maine

/
SHAPERO, PAUL
700 MOUNT HOPE AVE
BANGOR, ME 04401
HOVER, KAREN
205 FRENCH ST STE 2
BANGOR, ME 04401
LEVY, DAVID
417 STATE ST
BANGOR, ME 04401
COMEAU, STEPHEN
417 STATE ST
BANGOR, ME 04401
LAEGER, JANE
700 MOUNT HOPE AVE
BANGOR, ME 04401
BENTLEY, ELLEN
700 MOUNT HOPE AVE
BANGOR, ME 04401
WATERMAN, WAYNE
417 STATE ST
BANGOR, ME 04401
LENZ, RICHARD
885 UNION ST
BANGOR, ME 04401
HEINEMAN, FREDERICK
900 BROADWAY
BANGOR, ME 04401
PHILLIPS, LEWIS
336 MOUNT HOPE AVE
BANGOR, ME 04401
ZOLPER, WILLIAM
1365 BROADWAY
BANGOR, ME 04401
BOWMAN, JOHN
1 RIDGEWOOD DR
BANGOR, ME 04401
CUBBERLEY, THOMAS
489 STATE ST
BANGOR, ME 04401
WEITMAN, DAVID
498 ESSEX ST
BANGOR, ME 04401
JORDAN, JEFFREY
885 UNION ST
BANGOR, ME 04401
PITTIS, JEFFREY
90 RIDGEWOOD DR
BANGOR, ME 04401
BLOOM-FOSTER, JESSICA
895 UNION ST
BANGOR, ME 04401
CURTIS, JAMES
489 STATE ST
BANGOR, ME 04401
WHITEHOUSE, ROBERT
417 STATE ST
BANGOR, ME 04401
STOUT, CHRISTY
760 UNION STREET
BANGOR, ME 04401
MOSKIN, AVA
443 CONGRESS ST
PORTLAND, ME 04101
REYNOLDS, F
33 PENN PLZ
BANGOR, ME 04401
MACDUFFIE, HEATHER
348 BILLINGS RD
HERMON, ME 04401
DIPIERRO, FRANCIS
417 STATE ST
BANGOR, ME 04401
KLEMPERER, JOHN
489 STATE ST
BANGOR, ME 04401
Details
PAUL SHAPERO, MD
Phone Number
(207) 947-8658
Office Locations
700 MOUNT HOPE AVE
BANGOR, ME 04401
700 MOUNT HOPE AVE BANGOR ME, 04401

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.
2 question| 1 answer
what are out of network providers?
Q:
Asked by Anonymous 
Know the Answer? Answer this Question
Coverage in Maine
Q:I am considering a United HealthCare PPO in Florida and live in Maine 4 months in the summer. I reside in Waldo County (Stockton Springs) and want to determine the closest in-network services. In particular, are UHC PPOs in the Augusta or Bangor areas or are they only in the Portland area.
Asked by Ron 

1 answer

Know the Answer? Answer this Question
A: You may try the Physician Directory tool beside the Community Q & A section, if you can locate doctors after filling out the zip code, then it means that you are covered in the area. Alternatively, if you need plan recommendation, 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 1/28/2014 by davina

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