PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
UnitedHealthcare
CMS Rating
Plan Type
HMO
Annual Deductible
$290.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium
  • was the best selling plan in Collin in 2014

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Plan Doctors for Most Services
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$4,900 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Ambulance Services
$250 copay
Doctors Office Visits
Primary care physician visit: You pay nothing
Specialist visit: $30 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.
  • $250 copay per day for days 1 through 5

  • You pay nothing per day for days 6 through 90

  • Outpatient group therapy visit: $30 copay
    Outpatient individual therapy visit: $40 copay
    Outpatient hospital
    $250 per visit
    Renal dialysis
    20% per visit
    Inpatient Hospital Care
    Our plan covers an unlimited number of days for an inpatient hospital
    stay.
  • $250 copay per day for days 1 through 5

  • You pay nothing per day for days 6 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
    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): $30 copay
    Occupational therapy visit: $30 copay
    Physical therapy and speech and language therapy visit: $30 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): $30
    copay
    Vision Services
    Exam to diagnose and treat diseases and conditions of the eye (including
    yearly glaucoma screening): $0-30 copay, depending on the service
    Routine eye exam (for up to 1 every year): $30 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: $19 copay
    Outpatient x-rays: $15 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: You pay nothing
    Routine hearing exam (for up to 1 every year): You pay nothing
    Hearing aid: $175-225 copay for each hearing aid, depending on the type
    Renal Dialysis
    20% of the cost
    Outpatient Surgery
    Ambulatory surgical center: $250 copay
    Outpatient hospital: $250 copay
    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: $30 copay
    Routine foot care (for up to 6 visit(s) every year): $30 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 51

  • You pay nothing per day for days 52 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$14 copay$14 copayNot offered
    Tier 3: Preferred Brand Name$47 copay$47 copayNot offered
    Tier 4: Non-Preferred Brand Name$100 copay$100 copayNot offered
    Tier 5: Specialty Tier26% coinsurance26% 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$42 copay$42 copay$0 copay
    Tier 3: Preferred Brand Name$141 copay$141 copay$131 copay
    Tier 4: Non-Preferred Brand Name$300 copay$300 copay$290 copay
    Tier 5: Specialty Tier26% coinsurance26% coinsurance26% 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
    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 SecureHorizons (HMO) for Texas

    /
    SEBESTA, MICHAEL
    3100 N LEE TREVINO DR STE G
    EL PASO, TX 79936
    ENZ, JASON
    1416 GEORGE DIETER DR
    EL PASO, TX 79936
    PATTERSON, JOHN
    11680 PEBBLE HILLS BLVD
    EL PASO, TX 79936
    MALDONADO, YVONNE
    11965 PELLICANO DR
    EL PASO, TX 79936
    BAKER, NANNI
    11965 PELLICANO DR
    EL PASO, TX 79936
    WONG, KA
    1400 GEORGE DIETER DR
    EL PASO, TX 79936
    HOFFER, THOMAS
    2400 TRAWOOD DR
    EL PASO, TX 79936
    REED, TERESA
    1400 GEORGE DIETER DR
    EL PASO, TX 79936
    PADILLA, MANUEL
    1651 JOE BATTLE BLVD
    EL PASO, TX 79936
    BAKER, RONALD
    1418 B GEORGE DIETER AVE
    EL PASO, TX 79936
    SMITH, DEAN
    11880 VISTA DEL SOL DR
    EL PASO, TX 79936
    BELOCURA, JONNALYN
    11345 MONTWOOD DR
    EL PASO, TX 79936
    VELEZ, CARLOS
    11551 CEDAR OAK DR
    EL PASO, TX 79936
    ORTIZ, JORGE
    11400 VISTA DEL SOL DR
    EL PASO, TX 79936
    BROOKER, OLMER
    1418 GEORGE DIETER DR
    EL PASO, TX 79936
    SANDBERG, KEVIN
    1393 GEORGE DIETER DR
    EL PASO, TX 79936
    ARISTIZABAL, ANDRES
    1390 GEORGE DIETER DR
    EL PASO, TX 79936
    RESIGNATO, PAUL
    1722 N ZARAGOZA RD
    EL PASO, TX 79936
    AZARCON-SAMONTE, PATRICIA
    11544 VISTA DEL SOL DR
    EL PASO, TX 79936
    KHATEEB, MAZIN
    3235 TRAWOOD DR.
    EL PASO, TX 79936
    MANKAN, NAGENDER
    3022 TRAWOOD DR
    EL PASO, TX 79936
    RAMIREZ, AMADO
    1440 GEORGE DIETER DR STE C
    EL PASO, TX 79936
    MUNOZ, OSCAR
    11551 CEDAR OAK DR
    EL PASO, TX 79936
    IWALOYE, FEMI
    1671 N ZARAGOZA RD
    EL PASO, TX 79936
    ZERBACH, KATHRYN
    1400 GEORGE DIETER DR
    EL PASO, TX 79936
    Details
    MICHAEL SEBESTA, MD
    Phone Number
    (915) 592-7400
    Office Locations
    3100 N LEE TREVINO DR STE G
    EL PASO, TX 79936
    3100 N LEE TREVINO DR STE G EL PASO TX, 79936

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