2020 UnitedHealthcare MedicareDirect Essential (PFFS) H5435-1-0 in AZ from UnitedHealthcare | HealthPocket

UnitedHealthcare MedicareDirect Essential (PFFS)

$40/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C)
Insurance ProviderUnitedHealthcare
Plan IDH5435-1-0
Plan Year2020
CMS Rating
Plan TypePFFS
Annual Deductible$0.00
Out-of-Pocket Maximum0

What To Know About This Plan
  • This is a health coverage only plan with no drug coverage

Overview

Premium
Total monthly premium$40.00
Health plan premium$40.00
Standard Part B premium$135.50
Part B premium reductionNo
Deductible
Health plan deductible$0
Estimated yearly costs
Estimated total yearly costs for care$7,422.00
Out-of-pocket max
Out-of-pocket max$6,700

Benefits & costs

Doctor services
Primary doctor visit$25 per visit
Specialist visit$50 per visit
Tests, labs, & imaging
Diagnostic tests & procedures$25
Lab services$10
Diagnostic radiology services (like MRI)$0-150
Outpatient x-rays$14
Emergency care$90 per visit (always covered)
Urgent care$40 per visit (always covered)
Hospital services
Inpatient hospital coverage$395 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
Outpatient hospital coverage$0-395 per visit
Skilled nursing facility
Skilled nursing facility$0 per day for days 1 through 20
$160 per day for days 21 through 62
$0 per day for days 63 through 100
Preventive services
Preventive services$0 copay
Ambulance
Ground ambulance$250
Therapy services
Occupational therapy visit$40
Physical therapy & speech & language therapy visit$40
Mental health services
Outpatient group therapy with a psychiatrist$30
Outpatient individual therapy with a psychiatrist$40
Outpatient group therapy visit$30
Outpatient individual therapy visit$40
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)20% per item
Prosthetics (like braces, artificial limbs)20% per item
Diabetes supplies$0 per item

Extra benefits & costs

Hearing
Hearing exam$20
Fitting/evaluationNot covered
Hearing aids - Inner earNot covered
Hearing aids - Outer earNot covered
Hearing aids - Over the earNot covered
Preventive dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-raysNot covered
Comprehensive dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye exam$0 copay
Contact lensesNot covered
Eyeglasses (frames & lenses)Not covered
Eyeglass frames (only)Not covered
Eyeglass lenses (only)Not covered
UpgradesNot covered
More benefits
Over the counter drug benefitsNot covered
Meals for short durationNot covered
Annual physical examsLimited coverage
TelehealthNot covered

Drug coverage & costs

Part B drugs
Chemotherapy drugs20%
Other Part B drugs20%

Coverage Area for UnitedHealthcare MedicareDirect Essential (PFFS)

StateArizona
CountyYuma

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 managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain assessmentNot Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Rheumatoid arthritis management
Reducing the risk of falling
Improving bladder control
Medication reconciliation post-discharge
Plan all-cause readmissions
Statin Therapy for Patients with Cardiovascular Disease

Member Experience with Health Plan

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

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
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 availability
Appeals auto-forward
Appeals upheldNot Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
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
Medication adherence for diabetes medications
Medication adherence for hypertension - RAS antagonists
Medication adherence for cholesterol - Statins
MTM program completion rate for CMR
Statin use in persons with diabetes - SUPD

Physicians that accept UnitedHealthcare MedicareDirect Essential (PFFS) for Arizona

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William, Shea
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Hazem, Shehata
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Oliver, Severino
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Ahmad, Ashfaq
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Yanal, Masannat
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Keerti, Khandelwal
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Yuma Gastroenterology Pc
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Leona, Martin
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Renee, Monteiro
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Natalia, Galarza Carrazco
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Simi, Dhillon
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Nina, Greene
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George, Darwin
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Krishna, Nimmagadda
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Stephen, Njoroge
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Sunil, Deokule
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Kristine, Bernardo
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Darrell, Scheetz
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Nader, Haddad
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Dania, Sweidan
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Jemylene, Evangelista
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Henri, Carter
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William Shea, MD
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  • Phone Number
    (928) 317-2518
  • Office Locations
    1320 W 24th St
    Yuma, AZ 85364
1320 W 24th St Yuma AZ, 85364

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).