AARP MedicareComplete Choice (PPO)

Medicare Advantage Plan for Iowa

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH8768-1-0
CMS RatingNot Rated1
Plan TypePPO
Annual Deductible$0.00

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

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 $4,900 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:
$395 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:
$395 per visit
Out-of-Network:
40% per visit
Doctor visits
Primary:
In-Network:
$10 per visit
Out-of-Network:
$35 per visit
Specialist:
In-Network:
$40 per visit
Out-of-Network:
$55 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:
$2-10 or 40%
Lab services:
In-Network:
$2
Out-of-Network:
$2-10 or 40%
Diagnostic radiology services (e.g., MRI):
In-Network:
20%
Out-of-Network:
$2-10 or 40%
Outpatient x-rays:
In-Network:
$3
Out-of-Network:
$2-10 or 40%
Mental health services
In-Network:
$395 for days 1 through 4
$0 for days 5 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 51
$0 for days 52 through 100
Out-of-Network:
40% per stay
Rehabilitation services
Occupational therapy visit:
In-Network:
$40
Out-of-Network:
$55
Physical therapy and speech and language therapy visit:
In-Network:
$40
Out-of-Network:
$55
Ambulance
In-Network:
$250
Out-of-Network:
$250
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$40
Out-of-Network:
$55
Routine foot care:
In-Network:
$40
Out-of-Network:
$55
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 (PPO)

StateIowa
CountyPolk

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$10 copayNot offered
Tier 3: Preferred Brand NameNot offered$47 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$100 copayNot offered
Tier 5: Specialty TierNot offered33% 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$30 copay$0 copay
Tier 3: Preferred Brand NameNot offered$141 copay$131 copay
Tier 4: Non-Preferred Brand NameNot offered$300 copay$290 copay
Tier 5: Specialty TierNot offered33% coinsurance33% coinsurance

Physician Finder

Physicians that accept AARP MedicareComplete Choice (PPO) for Iowa

/
MULHAUSEN, PAUL
3509 E 29TH ST
DES MOINES, IA 50317
MOHR, BRITON
2918 E UNIVERSITY AVE
DES MOINES, IA 50317
MITRA, CHANDAN
3509 E 29TH ST
DES MOINES, IA 50317
NANSON, JOHN
1607 E 33RD ST
DES MOINES, IA 50317
HOCK, AMY
2918 E UNIVERSITY AVE
DES MOINES, IA 50317
CONVERY, LOUISE
3509 E 29TH ST
DES MOINES, IA 50317
YOUNT, DAVID
2459 E EUCLID AVE
DES MOINES, IA 50317
OLSON, LEATRICE
3509 E 29TH ST
DES MOINES, IA 50317
HAWKINS, RONNIE
3509 E 29TH ST
DES MOINES, IA 50317
QUINN, MICHAEL
700 E UNIVERSITY AVE
DES MOINES, IA 50316
GUTSHALL, TIMOTHY
1301 PENNSYLVANIA AVE
DES MOINES, IA 50316
MAYFIELD, TIMOTHY
1301 PENN AVE
DES MOINES, IA 50316
LIN, IAN
1301 PENN AVE
DES MOINES, IA 50316
MOON JR, KENNETH
2301 EAST 14TH STREET
DES MOINES, IA 50316
MITCHELL, MARIA
2301 E 14TH ST
DES MOINES, IA 50316
BERRY, GREGORY
1201 PENNSYLVANIA AVE
DES MOINES, IA 50316
WEIS, DENNIS
700 E UNIVERSITY AVE
DES MOINES, IA 50316
GANSKE, CORRINE
840 E UNIVERSITY AVE
DES MOINES, IA 50316
NEU, STACEY
840 E UNIVERSITY AVE
DES MOINES, IA 50316
PALAKURTHY, PRASAD
1301 PENN AVE
DES MOINES, IA 50316
CAHALAN, STEVEN
1301 PENN AVE
DES MOINES, IA 50316
ALBRECHT, JULIE
1301 PENN AVE
DES MOINES, IA 50316
LUEPKE, MICHAEL
1201 PENN AVE
DES MOINES, IA 50316
GAFFEY, JOHN
1301 PENN AVE STE 213
DES MOINES, IA 50316
Details
PAUL MULHAUSEN, MD
Phone Number
(515) 248-1600
Office Locations
3509 E 29TH ST
DES MOINES, IA 50317
3509 E 29TH ST DES MOINES IA, 50317

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