PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
UnitedHealthcare
CMS Rating
Plan Type
HMO
Annual Deductible
$180.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • was the best selling plan in Spokane in 2014

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Monthly Drug Plan Premium
$13.30
Health Plan Deductible
$0
Choice of Doctors?
Plan Doctors for Most Services
Monthly Health Plan Premium
$5.70
Out-Of-Pocket Spending Limit
$5,500 In-network
Optional Supplemental Benefits?
Yes
Prescription Drugs Covered?
Yes
Other Health Plan Deductibles?
No

Benefits

Service
Cost
Ambulance Services
$250 copay
Doctors Office Visits
Primary care physician visit: $10 copay
Specialist visit: $45 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
You pay nothing
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.
  • $395 copay per day for days 1 through 3

  • You pay nothing per day for days 4 through 90

  • Outpatient group therapy visit: $30 copay
    Outpatient individual therapy visit: $40 copay
    Outpatient hospital
    20% per visit
    Renal dialysis
    20% per visit
    Inpatient Hospital Care
    Our plan covers an unlimited number of days for an inpatient hospital
    stay.
  • $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
  • Diabetes Supplies and Services
    Diabetes monitoring supplies: You pay nothing
    Diabetes self-management training: You pay nothing
    Therapeutic shoes or inserts: 20% 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
    You pay nothing
    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: $30 copay
    Individual therapy visit: $40 copay
    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): $45 copay
    Occupational therapy visit: $40 copay
    Physical therapy and speech and language therapy visit: $40 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
    Dental Services
    Limited dental services (this does not include services in connection
    with care, treatment, filling, removal, or replacement of teeth): $45
    copay
    Vision Services
    Exam to diagnose and treat diseases and conditions of the eye (including
    yearly glaucoma screening): $0-45 copay, depending on the service
    Routine eye exam (for up to 1 every year): $45 copay
    Contact lenses: $0 copay
    Our plan pays up to $105 every two years for contact lenses.
    Eyeglass frames (for up to 1 every two years): $0 copay
    Our plan pays up to $70 every two years for eyeglass frames.
    Eyeglass lenses (for up to 1 every two years): You pay nothing
    Eyeglasses or contact lenses after cataract surgery: You pay nothing
    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): 20% of the cost
    Diagnostic tests and procedures: 20% of the cost
    Lab services: $20 copay
    Outpatient x-rays: $16 copay
    Therapeutic radiology services (such as radiation treatment for
    cancer): 20% of the cost
    Hearing Services
    Exam to diagnose and treat hearing and balance issues: $10 copay
    Routine hearing exam (for up to 1 every year): $10 copay
    Hearing aid: $390-450 copay for each hearing aid, depending on the
    type
    Renal Dialysis
    20% of the cost
    Outpatient Surgery
    Ambulatory surgical center: 20% of the cost
    Outpatient hospital: 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): $20 copay
    Durable Medical Equipment
    20% of the cost
    Foot Care
    Foot exams and treatment if you have diabetes-related nerve damage
    and/or meet certain conditions: $45 copay
    Routine foot care (for up to 6 visit(s) every year): $45 copay
    Urgent Care
    $30-40 copay, depending on the service
    Skilled Nursing Facility
    Our plan covers up to 100 days in a SNF.
  • You pay nothing per day for days 1 through 20

  • $160 copay per day for days 21 through 55

  • You pay nothing per day for days 56 through 100
  • Prosthetic Devices
    Prosthetic devices: 20% of the cost
    Related medical supplies: 20% of the cost

    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$2 copay$2 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 Tier29% coinsurance29% coinsuranceNot offered
    90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
    Tier 1: Preferred Generic$6 copay$6 copay$0 copay
    Tier 2: Non-Preferred Generic$24 copay$24 copay$0 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 Tier29% coinsurance29% coinsurance29% coinsurance

    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
    Not Rated
    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
    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
    Not Rated
    Reviewing appeals decisions
    Not Rated
    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
    Not Rated

    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 1 (HMO) for Washington

    /
    MORELLI, SHERYL
    6901 SAND POINT WAY NE
    SEATTLE, WA 98115
    SCARPELLO, KATHLEEN
    402 NE 72ND ST STE 2
    SEATTLE, WA 98115
    GARDEY, TAKLA
    6300 9TH AVE NE
    SEATTLE, WA 98115
    MAURI, KERRY
    9725 3RD AVE NE
    SEATTLE, WA 98115
    WINTERROTH, LISA
    9725 3RD AVE NE
    SEATTLE, WA 98115
    GALLOWAY, KAYLA
    460 NE 70TH STREET
    SEATTLE, WA 98115
    LONDERGAN, JULIE
    2705 NE 65TH ST
    SEATTLE, WA 98115
    FOSTER, MARIA
    6300 9TH AVE NE STE 106
    SEATTLE, WA 98115
    JACOBSEN, CARISSA
    460 NE 70TH STREET
    SEATTLE, WA 98115
    HEALY, PATRICIA
    460 NE 70TH ST
    SEATTLE, WA 98115
    WILLIAMS, CHRISTOPHER
    2021 NE 90TH ST
    SEATTLE, WA 98115
    NEWELL, STANLEY
    9501 5TH AVE NE
    SEATTLE, WA 98115
    MCCORMACK, ANNE
    6823 19TH AVE NE
    SEATTLE, WA 98115
    COLVEN, ROY
    325 9TH AVE, DERMATOLOGY SECTION
    SEATTLE, WA 98115
    SIMONS, BART
    7209 WOODLAWN AVE NE
    SEATTLE, WA 98115
    MOULTON, ROCKWELL
    7301 45TH AVE NE
    SEATTLE, WA 98115
    FURUKAWA, CLIFTON
    9725 3RD AVE NE
    SEATTLE, WA 98115
    KANTOR, STANLEY
    9208 ROOSEVELT WAY NE
    SEATTLE, WA 98115
    SPRENGER, JAY
    9725 3RD AVE NE
    SEATTLE, WA 98115
    SHAMSELDIN, MICHAEL
    7210 ROOSEVELT WAY NE
    SEATTLE, WA 98115
    GLOBERMAN, STACY
    9800 4TH AVE NE
    SEATTLE, WA 98115
    SZALAY, ANDREW
    7210 ROOSEVELT WAY NE
    SEATTLE, WA 98115
    SHAMSELDIN, SHANNON
    7210 ROOSEVELT WAY NE
    SEATTLE, WA 98115
    GREANEY, ANN
    7210 ROOSEVELT WAY NE
    SEATTLE, WA 98115
    LANGMAN, ALAN
    9714 3RD AVE NE SUITE 100
    RENTON, WA 98115
    Details
    SHERYL MORELLI, MD
    Phone Number
    (206) 987-6016
    Office Locations
    6901 SAND POINT WAY NE
    SEATTLE, WA 98115
    6901 SAND POINT WAY NE SEATTLE WA, 98115

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