PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
UnitedHealthcare
CMS Rating
Plan Type
Regional PPO SNP
Annual Deductible
$360.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • gives you freedom to choose which doctors, specialist and hospitals you visit
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
No
Choice of Doctors?
Any Doctor
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$6,700 In and Out-of-network $6,700 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
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost
  • Doctors Office Visits
    Primary care physician visit:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Specialist visit:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost
  • Emergency Care
    You pay nothing
    Home Health Care
  • In-network: You pay nothing

  • Out-of-network: 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.
  • In-network: You pay nothing

  • Out-of-network: In 2015 the amounts for each benefit period were:

  • $1,260 deductible for days 1 through 60

  • $315 copay per day for days 61 through 90

  • $630 copay per day for 60 lifetime reserve days

  • These amounts may change for 2016.
    Outpatient group therapy visit:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Outpatient individual therapy visit:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost
  • Outpatient hospital
    In-network: You pay nothing
    Out-of-network: You pay nothing
    Renal dialysis
    In-network: You pay nothing
    Out-of-network: You pay nothing
    Inpatient Hospital Care
    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: You pay nothing

  • Out-of-network: In 2015 the amounts for each benefit period were:

  • $1,260 deductible for days 1 through 60

  • $315 copay per day for days 61 through 90

  • $630 copay per day for 60 lifetime reserve days

  • These amounts may change for 2016.
    Diabetes Supplies and Services
    Diabetes monitoring supplies:
  • In-network: You pay nothing

  • Out-of-network: 20-30% of the cost, depending on the supply

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

  • Out-of-network: You pay nothing

  • Therapeutic shoes or inserts:
  • In-network: You pay nothing

  • Out-of-network: 20-30% of the cost, depending on the supply

  • 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
    Over-the- Counter Items
    Not covered
    Outpatient Substance Abuse
    Group therapy visit:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Individual therapy visit:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost
  • 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: You pay nothing

  • Out-of-network: 20% of the cost

  • Occupational therapy visit:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Physical therapy and speech and language therapy visit:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost
  • 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
  • In-network: You pay nothing

  • Out-of-network: You pay nothing
  • Dental Services
    Limited dental services (this does not include services in connection
    with care, treatment, filling, removal, or replacement of teeth):
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Preventive dental services:
  • Cleaning (for up to 1 every six months):

  • In-network: $0 copay

  • Out-of-network: $0 copay

  • Dental x-ray(s) (for up to 1):

  • In-network: $0 copay

  • Out-of-network: $0 copay

  • Oral exam (for up to 1 every six months):

  • In-network: $0 copay

  • Out-of-network: $0 copay

  • Our plan pays up to $500 every year for most dental services from any
    provider.
    Vision Services
    Exam to diagnose and treat diseases and conditions of the eye (including
    yearly glaucoma screening):
  • In-network: You pay nothing

  • Out-of-network: 0-20% of the cost, depending on the service

  • Routine eye exam (for up to 1 every year):
  • In-network: You pay nothing

  • Out-of-network: You pay nothing

  • Contact lenses
  • In-network: $0 copay

  • Out-of-network: $0 copay

  • Eyeglasses (frames and lenses):
  • In-network: $0 copay

  • Out-of-network: $0 copay

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

  • Out-of-network: 20% of the cost

  • Our plan pays up to $125 every year for contact lenses and eyeglasses
    (frames and lenses) from any provider.
    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: You pay nothing

  • Out-of-network: 20% of the cost

  • Diagnostic tests and procedures:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Lab services:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Outpatient x-rays:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Therapeutic radiology services (such as radiation treatment for cancer):
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost
  • Hearing Services
    Exam to diagnose and treat hearing and balance issues:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Routine hearing exam (for up to 1 every year):
  • In-network: You pay nothing

  • Out-of-network: You pay nothing

  • 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: You pay nothing

  • Out-of-network: 20% of the cost
  • Outpatient Surgery
    Ambulatory surgical center:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Outpatient hospital:
  • In-network: You pay nothing

  • 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: You pay nothing

  • Out-of-network: 20% of the cost
  • Durable Medical Equipment
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost
  • Foot Care
    Foot exams and treatment if you have diabetes-related nerve damage
    and/or meet certain conditions:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Routine foot care (for up to 6 visit(s) every year):
  • In-network: You pay nothing

  • Out-of-network: You pay nothing
  • Urgent Care
    You pay nothing
    Skilled Nursing Facility
    Our plan covers up to 100 days in a SNF.
  • In-network: You pay nothing

  • Out-of-network: In 2015 the amounts for each benefit period were:

  • You pay nothing for days 1 through 20

  • $157.50 copay per day for days 21 through 100

  • These amounts may change for 2016.
    Prosthetic Devices
    Prosthetic devices:
  • In-network: You pay nothing

  • Out-of-network: 20% of the cost

  • Related medical supplies:
  • In-network: You pay nothing

  • Out-of-network: 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$0 copay$0 copayNot offered
    Tier 2: Non-Preferred Generic$0 copay$0 copayNot offered
    Tier 3: Preferred Brand Name$0 copay$0 copayNot offered
    Tier 4: Non-Preferred Brand Name$0 copay$0 copayNot offered
    Tier 5: Specialty Tier$0 copay$0 copayNot offered
    90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
    Tier 1: Preferred Generic$0 copay$0 copay$0 copay
    Tier 2: Non-Preferred Generic$0 copay$0 copay$0 copay
    Tier 3: Preferred Brand Name$0 copay$0 copay$0 copay
    Tier 4: Non-Preferred Brand Name$0 copay$0 copay$0 copay
    Tier 5: Specialty Tier$0 copay$0 copay$0 copay

    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 Care Improvement Plus Dual Advantage (Regional PPO SNP) for Arkansas

    /
    CARNEY, JOHN
    11321 I-30
    LITTLE ROCK, AR 72209
    CARUTHERS, CAROL
    6924 GEYER SPRINGS RD
    LITTLE ROCK, AR 72209
    SNYDER, STEPHEN
    11321 INTERSTATE 30
    LITTLE ROCK, AR 72209
    CROWELL, KAREN
    11321 INTERSTATE 30
    LITTLE ROCK, AR 72209
    CROWELL, BERNARD
    11321 INTERSTATE 30
    LITTLE ROCK, AR 72209
    BADHWAR, ANIL
    11321 INTERSTATE 30
    LITTLE ROCK, AR 72209
    JOHN, CHRISTOPHER
    11321 INTERSTATE 30
    LITTLE ROCK, AR 72209
    ABDELAL, AHMED
    11321 INTERSTATE 30
    LITTLE ROCK, AR 72209
    HOP SKIP AND JUMP INC
    6917 GEYER SPRINGS RD
    LITTLE ROCK, AR 72209
    BUDHRAJA, MEENAKSHI
    11321 INTERSTATE 30
    LITTLE ROCK, AR 72209
    BUDHRAJA, MADHU
    11321 INTERSTATE 30
    LITTLE ROCK, AR 72209
    CRAWFORD, STANLEY
    11401 INTERSTATE 30
    LITTLE ROCK, AR 72209
    WOLVERTON, JOHN
    6924 GEYER SPRINGS
    LITTLE ROCK, AR 72209
    KUPERMAN, IRVING
    5300 MABELVALE PIKE
    LITTLE ROCK, AR 72209
    FINLEY, LARRY
    4202 S UNIVERSITY AVE
    LITTLE ROCK, AR 72204
    MILLER, FORREST
    4202 S UNIVERSITY AVE
    LITTLE ROCK, AR 72204
    HICKS, DAVID
    1000 S RODNEY PARHAM RD
    LITTLE ROCK, AR 72204
    CASPER, ROBERT
    4202 S UNIVERSITY AVE
    LITTLE ROCK, AR 72204
    NUGENT, RICHARD
    5800 W 10TH ST
    LITTLE ROCK, AR 72204
    VELEZ, LOUIS
    4202 S UNIVERSITY AVE
    LITTLE ROCK, AR 72204
    JOHNSON, CARL
    5320 W 12TH ST
    LITTLE ROCK, AR 72204
    FEURTADO, MARGARET
    4202 S UNIVERSITY AVE
    LITTLE ROCK, AR 72204
    LEWIS, DEREK
    6209 W 12TH ST
    LITTLE ROCK, AR 72204
    STOUT, MICHAEL
    4202 S UNIVERSITY AVE
    LITTLE ROCK, AR 72204
    JOHNSON, CLIFTON
    5800 W 10TH ST
    LITTLE ROCK, AR 72204
    Details
    JOHN CARNEY, MD
    Phone Number
    (501) 455-4700
    Office Locations
    11321 I-30
    LITTLE ROCK, AR 72209
    11321 I-30 LITTLE ROCK AR, 72209

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