AARP MedicareComplete Choice 1 (PPO)

Medicare Advantage Plan for Hawaii

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH2228-24-0
CMS Rating1
Plan TypePPO
Annual Deductible$315.00

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 2nd best selling plan in Honolulu in 2018

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$10,000 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
Inpatient hospital coverage
In-Network:
$450 for days 1 through 4
$0 for days 5 through 90
$0 for days 91 and beyond
Out-of-Network:
40% per stay
Outpatient hospital coverage
In-Network:
20% per visit
Out-of-Network:
40% per visit
Doctor visits
Primary:
In-Network:
$15 per visit
Out-of-Network:
$40 per visit
Specialist:
In-Network:
$50 per visit
Out-of-Network:
$70 per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
0-40%
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$30-40 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
20%
Out-of-Network:
$16-30 or 40%
Lab services:
In-Network:
$16
Out-of-Network:
$16-30 or 40%
Diagnostic radiology services (e.g., MRI):
In-Network:
20%
Out-of-Network:
$16-30 or 40%
Outpatient x-rays:
In-Network:
$25
Out-of-Network:
$16-30 or 40%
Mental health services
In-Network:
$450 for days 1 through 3
$0 for days 4 through 90
Out-of-Network:
40% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$30
Out-of-Network:
$35-45
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
$35-45
Outpatient group therapy visit:
In-Network:
$30
Out-of-Network:
$35-45
Outpatient individual therapy visit:
In-Network:
$40
Out-of-Network:
$35-45
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$160 for days 21 through 62
$0 for days 63 through 100
Out-of-Network:
$195 for days 1 through 52
$0 for days 53 through 100
Rehabilitation services
Occupational therapy visit:
In-Network:
$40
Out-of-Network:
$70
Physical therapy and speech and language therapy visit:
In-Network:
$40
Out-of-Network:
$70
Ambulance
In-Network:
$225
Out-of-Network:
$225
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$50
Out-of-Network:
$70
Routine foot care:
In-Network:
$50
Out-of-Network:
$70
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
50% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
40% per item
Diabetes supplies:
In-Network:
$0 per item
Out-of-Network:
40% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
40%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
40%

Coverage Area for AARP MedicareComplete Choice 1 (PPO)

StateHawaii
CountyHonolulu

Cost Sharing Information

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$3 copayNot offered
Tier 2: Non-Preferred GenericNot offered$12 copayNot offered
Tier 3: Preferred Brand NameNot offered$45 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$95 copayNot offered
Tier 5: Specialty TierNot offered26% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$9 copay$0 copay
Tier 2: Non-Preferred GenericNot offered$36 copay$0 copay
Tier 3: Preferred Brand NameNot offered$135 copay$125 copay
Tier 4: Non-Preferred Brand NameNot offered$285 copay$275 copay
Tier 5: Specialty TierNot offered26% 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 Choice 1 (PPO) for Hawaii

/
AYON, DENNIS
5333 LIKINI ST
HONOLULU, HI 96818
COLE, JASMIN
755 SCOTT CIR
HICKAM AFB, HI 96853
WONG, MELVIN
98-1247 KAAHUMANU ST STE 318
AIEA, HI 96701
NAKAMOTO, HARVEY
99-128 AIEA HEIGHTS DR
AIEA, HI 96701
SHIMOMURA, GREGG
99 128 AIEA HEIGHTS DRIVE
AIEA, HI 96701
SHARIPOVA, ELENA
99-128 AIEA HEIGHTS DR
AIEA, HI 96701
NGUYEN, JIHEE
99-080 KAUHALE ST STE D9
AIEA, HI 96701
BAKER, MARK
98-1079 MOANALUA RD
AIEA, HI 96701
WILCOX, DONALD
98-1079 MOANALUA RD
AIEA, HI 96701
GIL, DINORA
98-1079 MOANALUA RD
AIEA, HI 96701
CANONICO, ROBERT
98-1079 MOANALUA RD
AIEA, HI 96701
CHEN, HONG-RU
98-1079 MOANALUA RD
AIEA, HI 96701
TERAMOTO, RAY
98-211 PALI MOMI ST
AIEA, HI 96701
JENKS, LINDA
98-1079 MOANALUA RD
AIEA, HI 96701
CHINEN, SHERI
888 SOUTH KING ST.
AIEA, HI 96701
TOM, RUSSELL
98-1079 MOANALUA RD
AIEA, HI 96701
KUROSAWA, MICHAEL
98-151 PALI MOMI ST
AIEA, HI 96701
FUJITA, WAYNE
99-128 AIEA HEIGHTS DR
AIEA, HI 96701
CHUNG, RYAN
98-1079 MOANALUA ROAD
AIEA, HI 96701
WONG, ROBERT
98-211 PALI MOMI STREET
AIEA, HI 96701
FONG, JENIFER
98-151 PALI MOMI ST
AIEA, HI 96701
NGUYEN, MARISA
98-151 PALI MOMI ST
AIEA, HI 96701
LENCINAS, CLAUDIO
98-151 PALI MOMI ST
AIEA, HI 96701
LEE, KENNETH
98-151 PALI MOMI ST
AIEA, HI 96701
GRIEF, MARK
98-1079 MOANALUA RD
AIEA, HI 96701
Details
DENNIS AYON, M.D.
Phone Number
(808) 594-7845
Office Locations
5333 LIKINI ST
HONOLULU, HI 96818
5333 LIKINI ST HONOLULU HI, 96818

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