2018 Erickson Advantage Guardian (HMO-POS SNP) H5652-3-0 in CO from UnitedHealthcare | HealthPocket

Erickson Advantage Guardian (HMO-POS SNP)

$393/mo

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Zip Code80219
Applicant10/23/1983 Male
Coverage Start10/24/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH5652-3-0
Plan Year2018
CMS Rating
Plan TypeHMO-POS SNP
Annual Deductible$0.00

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2019. see plan

Why We Like This Plan
  • has both Health and Drug Coverage

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsNo
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$500 In-network
Other health plan deductibles?No
Health Plan Deductible$0
Monthly Drug Plan Premium$32.80
Monthly Health Plan Premium$0.00

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:
$0 for days 1 through 90
$0 for days 91 and beyond
Out-of-Network:
30% per stay
Outpatient hospital coverageIn-Network:
$0 copay
Out-of-Network:
30% per visit
Doctor visitsPrimary:
In-Network:
$0 copay
Out-of-Network:
30% per visit
Specialist:
In-Network:
$0 copay
Out-of-Network:
30% per visit
Preventive careIn-Network:
$0 copay
Out-of-Network:
0-30%
Emergency care/Urgent careEmergency:
$50 per visit (always covered)
Urgent care:
$20 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:
$0 copay
Out-of-Network:
30%
Lab services:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Diagnostic radiology services (e.g., MRI):
In-Network:
$0 copay
Out-of-Network:
30%
Outpatient x-rays:
In-Network:
$0 copay
Out-of-Network:
30%
Mental health servicesIn-Network:
$0 for days 1 through 90
Out-of-Network:
30% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$0 copay
Out-of-Network:
30%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$0 copay
Out-of-Network:
30%
Outpatient group therapy visit:
In-Network:
$0 copay
Out-of-Network:
30%
Outpatient individual therapy visit:
In-Network:
$0 copay
Out-of-Network:
30%
Skilled Nursing FacilityIn-Network:
$0 for days 1 through 100
Out-of-Network:
30% per stay
Rehabilitation servicesOccupational therapy visit:
In-Network:
$0 copay
Out-of-Network:
30%
Physical therapy and speech and language therapy visit:
In-Network:
$0 copay
Out-of-Network:
30%
AmbulanceIn-Network:
$50
Out-of-Network:
$50
TransportationIn-Network:
$0 copay
Foot care (podiatry services)Foot exams and treatment:
In-Network:
$0 copay
Out-of-Network:
30%
Routine foot care:
In-Network:
$0 copay
Out-of-Network:
30%
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
$0 copay
Out-of-Network:
30% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
$0 copay
Out-of-Network:
30% per item
Diabetes supplies:
In-Network:
$0 copay
Out-of-Network:
30% per item
Wellness programs (e.g., fitness, nursing hotline)Not covered
Medicare Part B drugsChemotherapy:
In-Network:
$0 copay
Out-of-Network:
30%
Other Part B drugs:
In-Network:
$0 copay
Out-of-Network:
30%

Coverage Area for Erickson Advantage Guardian (HMO-POS SNP)

StateColorado
CountyDenver

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds$0 copayNot offered
Tier 2: Non-Preferred GenericNot offered$0 copayNot offered
Tier 3: Preferred Brand NameNot offered$28 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$70 copayNot offered
Tier 5: Specialty TierNot offered33% coinsuranceNot offered

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$0 copay$0 copay
Tier 2: Non-Preferred GenericNot offered$0 copay$0 copay
Tier 3: Preferred Brand NameNot offered$84 copay$74 copay
Tier 4: Non-Preferred Brand NameNot offered$210 copay$200 copay
Tier 5: Specialty TierNot offered33% coinsurance33% coinsurance

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 - MedicalNot Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - DrugsNot Rated
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 planNot Rated
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

Physicians that accept Erickson Advantage Guardian (HMO-POS SNP) for Colorado

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Fisher, Larry
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Elles, Mark
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Vanbang, Antony Nguyen
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Ngo, Cuong
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Garrett, Raymond
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Nguyen, Dinh
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Sutherland, Jesse
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Nguyen, Khoi
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Durbin, Roy
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Mccranie, Kathy
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Lambden, Brian
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Basse, Rachel
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Johannes, Robert
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Thumim, Martin
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Wang, Prosper
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Laubach, Sherri
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Pham, Loan
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Larry Fisher, MD
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  • Phone Number
    (303) 935-9142
  • Office Locations
    1930 S Federal Blvd
    Denver, CO 80219
1930 S Federal Blvd Denver CO, 80219

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