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

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

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Monthly Drug Plan Premium
Not Applicable
Health Plan Deductible
$0
Choice of Doctors?
Any Doctor
Monthly Health Plan Premium
$0.00
Out-Of-Pocket Spending Limit
$10,000 In and Out-of-network $6,700 In-network
Optional Supplemental Benefits?
No
Prescription Drugs Covered?
No
Other Health Plan Deductibles?
No

Benefits

Service
Cost
Ambulance Services
  • In-network: $275 copay

  • Out-of-network: $275 copay
  • Doctors Office Visits
    Primary care physician visit:
  • In-network: $15 copay

  • Out-of-network: $45 copay

  • Specialist visit:
  • In-network: $50 copay

  • Out-of-network: $70 copay
  • Emergency Care
    $75 copay
    If you are admitted to the hospital within 24 hours, you do not have to
    pay your share of the cost for emergency care. See the "Inpatient
    Hospital Care" section of this booklet for other costs.
    Home Health Care
  • In-network: You pay nothing

  • Out-of-network: 50% of the cost
  • Mental Health Care
    Inpatient visit:
    Our plan covers up to 190 days in a lifetime for inpatient mental health
    care in a psychiatric hospital. The inpatient hospital care limit does not
    apply to inpatient mental services provided in a general hospital.
    Our plan covers 90 days for an inpatient hospital stay.
    Our plan also covers 60 "lifetime reserve days." These are "extra" days
    that we cover. If your hospital stay is longer than 90 days, you can use
    these extra days. But once you have used up these extra 60 days, your
    inpatient hospital coverage will be limited to 90 days.
  • In-network:

  • $395 copay per day for days 1 through 3

  • You pay nothing per day for days 4 through 90

  • Out-of-network:

  • 40% of the cost per stay

  • Outpatient group therapy visit:
  • In-network: $30 copay

  • Out-of-network: $35-45 copay, depending on the service

  • Outpatient individual therapy visit:
  • In-network: $40 copay

  • Out-of-network: $35-45 copay, depending on the service
  • Outpatient hospital
    In-network: 20% per visit
    Out-of-network: 40% per visit
    Renal dialysis
    In-network: 20% per visit
    Out-of-network: 20% per visit
    Inpatient Hospital Care
    Our plan covers an unlimited number of days for an inpatient hospital
    stay.
  • In-network:

  • $395 copay per day for days 1 through 4

  • You pay nothing per day for days 5 through 90

  • You pay nothing per day for days 91 and beyond

  • Out-of-network:

  • 40% of the cost per stay
  • Diabetes Supplies and Services
    Diabetes monitoring supplies:
  • In-network: You pay nothing

  • Out-of-network: 40% of the cost

  • Diabetes self-management training:
  • In-network: You pay nothing

  • Out-of-network: 40% of the cost

  • Therapeutic shoes or inserts:
  • In-network: 20% of the cost

  • Out-of-network: 40% of the cost

  • The plan covers the following brands of blood glucose monitors and test
    strips: OneTouch UltraMini, OneTouch Ultra 2 System, OneTouch
    Verio IQ, OneTouch Verio Sync, ACCU-CHEK Nano SmartView,
    ACCU-CHEK Aviva Plus
    Acupuncture
    Not covered
    Preventive Care
  • In-network: You pay nothing

  • Out-of-network: 0-40% of the cost, depending on the service

  • Our plan covers many preventive services, including:
  • Abdominal aortic aneurysm screening

  • Alcohol misuse counseling

  • Bone mass measurement

  • Breast cancer screening (mammogram)

  • Cardiovascular disease (behavioral therapy)

  • Cardiovascular screenings

  • Cervical and vaginal cancer screening

  • Colorectal cancer screenings (Colonoscopy, Fecal occult blood test,

  • Flexible sigmoidoscopy)
  • Depression screening

  • Diabetes screenings

  • HIV screening

  • Medical nutrition therapy services

  • Obesity screening and counseling

  • Prostate cancer screenings (PSA)

  • Sexually transmitted infections screening and counseling

  • Tobacco use cessation counseling (counseling for people with no sign

  • of tobacco-related disease)
  • Vaccines, including Flu shots, Hepatitis B shots, Pneumococcal shots

  • "Welcome to Medicare" preventive visit (one-time)

  • Yearly "Wellness" visit

  • Any additional preventive services approved by Medicare during the
    contract year will be covered.
    Over-the- Counter Items
    Not covered
    Outpatient Substance Abuse
    Group therapy visit:
  • In-network: $30 copay

  • Out-of-network: $35-45 copay, depending on the service

  • Individual therapy visit:
  • In-network: $40 copay

  • Out-of-network: $35-45 copay, depending on the service
  • Outpatient Rehabilitation
    Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per
    day for up to 36 sessions up to 36 weeks):
  • In-network: $50 copay

  • Out-of-network: $70 copay

  • Occupational therapy visit:
  • In-network: $40 copay

  • Out-of-network: $70 copay

  • Physical therapy and speech and language therapy visit:
  • In-network: $40 copay

  • Out-of-network: $70 copay
  • Hospice
    You pay nothing for hospice care from a Medicare-certified hospice. You
    may have to pay part of the costs for drugs and respite care. Hospice is
    covered outside of our plan. Please contact us for more details.
    Transportation
    Not covered
    Vision Services
    Exam to diagnose and treat diseases and conditions of the eye (including
    yearly glaucoma screening):
  • In-network: $0-50 copay, depending on the service

  • Out-of-network: $70 copay

  • Routine eye exam (for up to 1 every year):
  • In-network: $50 copay

  • Out-of-network: $70 copay

  • Eyeglasses or contact lenses after cataract surgery:
  • In-network: You pay nothing

  • Out-of-network: 40% of the cost
  • Diagnostic Tests, Lab and Radiology Services, and X-Rays (Costs for these services may vary based on place of service)
    Diagnostic radiology services (such as MRIs, CT scans):
  • In-network: 20% of the cost

  • Out-of-network: 40% of the cost

  • Diagnostic tests and procedures:
  • In-network: 20% of the cost

  • Out-of-network: 40% of the cost

  • Lab services:
  • In-network: $5 copay

  • Out-of-network: $5 copay

  • Outpatient x-rays:
  • In-network: $3 copay

  • Out-of-network: $4 copay

  • Therapeutic radiology services (such as radiation treatment for cancer):
  • In-network: 20% of the cost

  • Out-of-network: 40% of the cost
  • Hearing Services
    Exam to diagnose and treat hearing and balance issues:
  • In-network: $15 copay

  • Out-of-network: $70 copay

  • Routine hearing exam (for up to 1 every year):
  • In-network: $15 copay

  • Out-of-network: $70 copay

  • Hearing aid:
  • In-network: $330-380 copay for each hearing aid, depending on the

  • type
  • Out-of-network: $330-380 copay for each hearing aid, depending on

  • the type
    Renal Dialysis
  • In-network: 20% of the cost

  • Out-of-network: 20% of the cost
  • Chiropractic Care
    Manipulation of the spine to correct a subluxation (when 1 or more of the
    bones of your spine move out of position):
  • In-network: $20 copay

  • Out-of-network: $70 copay
  • Durable Medical Equipment
  • In-network: 20% of the cost

  • Out-of-network: 50% of the cost
  • Foot Care
    Foot exams and treatment if you have diabetes-related nerve damage
    and/or meet certain conditions:
  • In-network: $50 copay

  • Out-of-network: $70 copay

  • Routine foot care (for up to 6 visit(s) every year):
  • In-network: $50 copay

  • Out-of-network: $70 copay
  • Urgent Care
    $30-40 copay, depending on the service
    Skilled Nursing Facility
    Our plan covers up to 100 days in a SNF.
  • In-network:

  • You pay nothing per day for days 1 through 20

  • $160 copay per day for days 21 through 62

  • You pay nothing per day for days 63 through 100

  • Out-of-network:

  • $195 copay per day for days 1 through 52

  • You pay nothing per day for days 53 through 100
  • Prosthetic Devices
    Prosthetic devices:
  • In-network: 20% of the cost

  • Out-of-network: 40% of the cost

  • Related medical supplies:
  • In-network: 20% of the cost

  • Out-of-network: 40% of the cost
  • CMS Ratings

    Staying healthy - screenings, tests and vaccines

    Breast cancer screening
    Colorectal cancer screening
    Annual flu vaccine
    Improving or maintaining physical health
    Improving or maintaining mental health
    Monitoring physical ability
    Adult BMI assessment

    Managing Chronic Conditions

    Special needs plan care management
    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
    Controlling blood pressure
    Rheumatoid arthritis management
    Reducing the risk of falling
    Plan all-cause readmissions

    Member Experience with Health Plan

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

    Member Complaints, and Changes in Health Plan's Performance

    Complaints about the health plan
    Members choosing to leave the health plan
    Beneficiary access and performance problems
    Health plan quality improvement

    Health Plan Customer Service

    Plan makes timely decision about appeals
    Reviewing appeals decisions
    Call center – foreign language interpreter and TTY/TDD availability - Medical

    Drug Plan Customer Service

    Call center – foreign language interpreter and TTY/TDD availability - Drugs
    Appeals auto-forward
    Appeals upheld

    Member Complaints, and Changes in Drug Plan's Performance

    Complaints about the drug plan
    Members choosing to leave the drug plan
    Beneficiary access and performance problems
    Drug plan quality improvement

    Member Experience with Drug Plan

    Rating of drug plan
    Getting needed prescription drugs

    Drug Pricing and Patient Safety

    MPF Price Accuracy
    High risk medication
    Part D medication adherence for diabetes
    Part D medication adherence for hypertension
    Part D medication adherence for cholesterol
    Medication Therapy Management program completion rate

    Physician Finder

    Physicians that accept AARP MedicareComplete Choice Essential (Regional PPO) for Florida

    /
    GENAO, ESTEBAN
    13059 SW 112TH ST
    MIAMI, FL 33186
    SCHNEIDER, JESSICA
    12608 SW 88TH ST
    MIAMI, FL 33186
    MCCARTHY, LIAM
    11801 SW 90TH ST
    MIAMI, FL 33186
    MANIGLIA, MARIELBA
    13632 SW 88TH ST
    MIAMI, FL 33186
    GARCIA-ORTIZ, SANDRA
    11435 SW 133RD CT APT 3
    MIAMI, FL 33186
    HERNANDEZ, OSCAR
    14221 SW 120TH ST
    MIAMI, FL 33186
    JIMENEZ, MILTON
    12002 SW 128TH CT STE 204
    MIAMI, FL 33186
    FEITO, PATRICIA
    12314 SW 127TH AVE
    MIAMI, FL 33186
    JARRETT, WENTWORTH
    12955 SW 132ND ST
    MIAMI, FL 33186
    NUNEZ, RIGOBERTO
    8900 SW 117TH AVE
    MIAMI, FL 33186
    PONS, FRANCISCO
    13500 SW 88TH ST
    MIAMI, FL 33186
    RAJADHYAKSHA, AMAR
    11801 SW 90TH ST
    MIAMI, FL 33186
    CINTAS, MAURA
    9000 SW 137TH AVE
    MIAMI, FL 33186
    RODICIO, ILEANA
    9000 SW 137TH AVE
    MIAMI, FL 33186
    MAYORGA, RENE
    14261 SW 120TH ST STE 110
    MIAMI, FL 33186
    BUIA, MONTSERRAT
    11801 SW 90TH ST
    MIAMI, FL 33186
    URGENT CARE PHYSICIANS OF WEST KENDALL LLC
    13001 SW 88TH ST
    MIAMI, FL 33186
    CRUZ, FRANCISCO
    13500 N KENDALL DR
    MIAMI, FL 33186
    APOLLON, KATIA
    8900 SW 117TH AVE
    MIAMI, FL 33186
    KARSENTI, REBECCA
    8900 SW 117TH AVE
    MIAMI, FL 33186
    GOYKHMAN, GARY
    11801 SW 90TH ST
    MIAMI, FL 33186
    GUPTA, PADMA
    13500 SW 88TH ST
    MIAMI, FL 33186
    GOMEZ, MANUEL
    13000 SW 117 STREET
    MIAMI, FL 33186
    PELAEZ, ANNETTE
    8900 SW 117TH AVE
    MIAMI, FL 33186
    GERSTEN, JANET
    8900 SW 117TH AVE
    MIAMI, FL 33186
    Details
    ESTEBAN GENAO, MD FAAP
    Phone Number
    (305) 387-2060
    Office Locations
    13059 SW 112TH ST
    MIAMI, FL 33186
    13059 SW 112TH ST MIAMI FL, 33186

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