2018 UnitedHealthcare Nursing Home Plan (PPO SNP) H0710-15-0 in ME from UnitedHealthcare | HealthPocket

UnitedHealthcare Nursing Home (PPO SNP)

Medicare Advantage Plan for Maine

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH0710-15-0
CMS Rating1
Plan TypePPO SNP
Annual Deductible$405.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
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
$34.30
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$1,300 per stay
Out-of-Network:
$1,300 per stay
Outpatient hospital coverage
In-Network:
20% per visit
Out-of-Network:
30% per visit
Doctor visits
Primary:
In-Network:
$0 copay
Out-of-Network:
30% per visit
Specialist:
In-Network:
0-20% per visit
Out-of-Network:
30% per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
0-30%
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$65 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
0-20%
Out-of-Network:
30%
Lab services:
In-Network:
$0
Out-of-Network:
$0 copay
Diagnostic radiology services (e.g., MRI):
In-Network:
0-20%
Out-of-Network:
30%
Outpatient x-rays:
In-Network:
$0
Out-of-Network:
30%
Mental health services
In-Network:
$1,300 per stay
Out-of-Network:
$1,300 per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
0-20%
Out-of-Network:
30%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
0-20%
Out-of-Network:
30%
Outpatient group therapy visit:
In-Network:
0-20%
Out-of-Network:
30%
Outpatient individual therapy visit:
In-Network:
0-20%
Out-of-Network:
30%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 100
Out-of-Network:
30% per stay
Rehabilitation services
Occupational 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%
Ambulance
In-Network:
20%
Out-of-Network:
20%
Transportation
In-Network:
$0 copay
Out-of-Network:
75%
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
0-20%
Out-of-Network:
30%
Routine foot care:
In-Network:
$0
Out-of-Network:
30%
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
30% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
0-20% per item
Out-of-Network:
30% per item
Diabetes supplies:
In-Network:
20% per item
Out-of-Network:
30% per item
Wellness programs (e.g., fitness, nursing hotline)
Not covered
Medicare Part B drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
30%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
30%

Coverage Area for UnitedHealthcare Nursing Home (PPO SNP)

StateMaine
CountyPenobscot

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 offereds25% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered25% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered25% coinsuranceNot offered
Tier 4: Non-Preferred Brand NameNot offered25% coinsuranceNot offered
Tier 5: Specialty TierNot offered25% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered25% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered25% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered25% coinsuranceNot offered
Tier 4: Non-Preferred Brand NameNot offered25% coinsuranceNot offered
Tier 5: Specialty TierNot offered25% coinsuranceNot offered

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Not Rated
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
Not Rated
Overall rating of health care quality
Not Rated
Overall rating of plan
Not Rated
Care Coordination
Not Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Not Rated
Members choosing to leave the health plan
Not Rated
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
Not 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
Not Rated
High risk medication
Not Rated
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 UnitedHealthcare Nursing Home (PPO SNP) for Maine

/
Thompson, Peter
1365 Broadway
Bangor, ME 04401
Dahl, William
205 French St
Bangor, ME 04401
Courtney, Thomas
133 Corporate Dr
Bangor, ME 04401
Dani, Sourbha
1 Northeast Dr
Bangor, ME 04401
Bruehl, Michael
133 Corporate Dr
Bangor, ME 04401
Larochelle, Jacques
489 State St
Bangor, ME 04401
Khasani, Sina
498 Essex St
Bangor, ME 04401
Thom, Kristin
895 Union St
Bangor, ME 04401
Berry, James
489 State St
Bangor, ME 04401
Krishnan, Ramesh
Nicu Professional Services Emmc
Bangor, ME 04401
Martin, Thomas
417 State St Ste 305
Bangor, ME 04401
Thompson, Stephen
925 Union St Ste 3
Bangor, ME 04401
Khadka, Poonam
900 Broadway
Bangor, ME 04401
Graustein, Bradley
489 State St
Bangor, ME 04401
Mohan, Vinod
417 State St Ste 412
Bangor, ME 04401
O'leary Carpenter, Keenan
489 State St
Bangor, ME 04401
Surran, Brooke
133 Corporate Dr
Bangor, ME 04401
Woessner, Erin
895 Union St
Bangor, ME 04401
Sandor, Frantisek
417 State St
Bangor, ME 04401
Nicholas, Karolyn
417 State St
Bangor, ME 04401
Details
Peter Thompson, MD
Phone Number
(207) 942-6226
Office Locations
1365 Broadway
Bangor, ME 04401
1365 Broadway Bangor ME, 04401

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