2018 Care Improvement Plus Dual Advantage (Regional PPO SNP) R7444-11-0 in GA from UnitedHealthcare

Insurance Type	Medicare Advantage Plan (Part C w/ RX)
Insurance Provider	UnitedHealthcare
Plan ID	R7444-11-0
CMS Rating	1
Plan Type	Regional PPO SNP
Annual Deductible	$405.00

Plan Details

Costs and Other Important Information

Plan Year:

2018

Optional Supplemental Benefits

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$6,700 In and Out-of-network $6,700 In-network

Other health plan deductibles?

Health Plan Deductible

Monthly Drug Plan Premium

$0.00

Monthly Health Plan Premium

$0.00

Benefits

Service

Cost

Inpatient hospital coverage

In-Network:
$0 copay
Out-of-Network:
$1,300 per stay

Outpatient hospital coverage

In-Network:
$0 copay
Out-of-Network:
20% per visit

Doctor visits

Primary:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Specialist:
In-Network:
$0 copay
Out-of-Network:
$0 copay

Preventive care

In-Network:
$0 copay
Out-of-Network:
$0 copay

Emergency care/Urgent care

Emergency:
$0 copay
Urgent care:
$0 copay

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures:
In-Network:
$0 copay
Out-of-Network:
20%
Lab services:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Diagnostic radiology services (e.g., MRI):
In-Network:
$0 copay
Out-of-Network:
20%
Outpatient x-rays:
In-Network:
$0 copay
Out-of-Network:
20%

Mental health services

In-Network:
$0 copay
Out-of-Network:
$1,300 per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Outpatient group therapy visit:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Outpatient individual therapy visit:
In-Network:
$0 copay
Out-of-Network:
$0 copay

Skilled Nursing Facility

In-Network:
$0 copay
Out-of-Network:
Coming soon

Rehabilitation services

Occupational therapy visit:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Physical therapy and speech and language therapy visit:
In-Network:
$0 copay
Out-of-Network:
$0 copay

Ambulance

In-Network:
$0 copay
Out-of-Network:
20%

Transportation

In-Network:
$0 copay
Out-of-Network:
$0 copay

Foot care (podiatry services)

Foot exams and treatment:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Routine foot care:
In-Network:
$0 copay
Out-of-Network:
$0 copay

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
$0 copay
Out-of-Network:
20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
$0 copay
Out-of-Network:
20% per item
Diabetes supplies:
In-Network:
$0 copay
Out-of-Network:
20-30% per item

Wellness programs (e.g., fitness, nursing hotline)

Covered

Medicare Part B drugs

Chemotherapy:
In-Network:
$0 copay
Out-of-Network:
20%
Other Part B drugs:
In-Network:
$0 copay
Out-of-Network:
20%

Coverage Area for Care Improvement Plus Dual Advantage (Regional PPO SNP)

State	Georgia
County	Gwinnett

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day Supply	Preferred Retail Pharmacies	Non-Preferred Retail Pharmacies	Mail-Order Pharmacies
Tier 1: Preferred Generic	Not offereds	$0 copay	Not offered
Tier 2: Non-Preferred Generic	Not offered	$0 copay	Not offered
Tier 3: Preferred Brand Name	Not offered	$0 copay	Not offered
Tier 4: Non-Preferred Brand Name	Not offered	$0 copay	Not offered
Tier 5: Specialty Tier	Not offered	$0 copay	Not offered

90 Day Supply	Preferred Retail Pharmacies	Non-Preferred Retail Pharmacies	Mail-Order Pharmacies
Tier 1: Preferred Generic	Not offered	$0 copay	Not offered
Tier 2: Non-Preferred Generic	Not offered	$0 copay	Not offered
Tier 3: Preferred Brand Name	Not offered	$0 copay	Not offered
Tier 4: Non-Preferred Brand Name	Not offered	$0 copay	Not offered
Tier 5: Specialty Tier	Not offered	$0 copay	Not offered

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

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 Georgia

Last Name

Location/Distance

Gender

FITZGERALD-SOAPES, S

3685 LAWRENCEVILLE HWY

LAWRENCEVILLE, GA 30044

Premium	Plan Name
from $0 Select	Kaiser Permanente Senior Advantage Basic (HMO)	Details
from $26 Select	SilverScript Choice (PDP)	Details
from $0 Select	Aetna Medicare Select Plan (HMO)	Details
from $22 Select	Express Scripts Medicare - Saver (PDP)	Details
from $20 Select	Humana Walmart Rx Plan (PDP)	Details

Care Improvement Plus Dual Advantage (Regional PPO SNP)

Medicare Advantage Plan for Georgia

Plan Summary

What To Know About This Plan

Why We Like This Plan