2019 AARP MedicareComplete Headwaters (PPO) H7404-1-0 in MN from UnitedHealthcare | HealthPocket

AARP MedicareComplete Headwaters (PPO)

$24/mo

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Zip Code55106
Applicant8/26/1984 Male
Coverage Start8/27/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH7404-1-0
Plan Year2019
CMS RatingNot Rated
Plan TypePPO
Annual Deductible$395.00

What To Know About This Plan
  • This plan has health and drug coverage

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

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$24.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$10,000 In and Out-of-network
$6,700 In-network
Optional Supplemental BenefitsYes

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$450 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
Out-of-Network:40% per stay
Outpatient hospital coverageIn-Network:20% per visit
Out-of-Network:40% per visit
Doctor visitsPrimary:
In-Network:$20 per visit
Out-of-Network:40% per visit
Specialist:
In-Network:$50 per visit
Out-of-Network:40% per visit
Preventive careIn-Network:$0 copay
Out-of-Network:0-40%
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$30-40 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:20%
Out-of-Network:40%
Lab services:
In-Network:$10
Out-of-Network:$10
Diagnostic radiology services (e.g., MRI):
In-Network:20%
Out-of-Network:40%
Outpatient x-rays:
In-Network:$14
Out-of-Network:$21
Mental health servicesInpatient hospital - psychiatric:
In-Network:$450 per day for days 1 through 3
$0 per day 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 FacilityIn-Network:$0 per day for days 1 through 20
$160 per day for days 21 through 62
$0 per day for days 63 through 100
Out-of-Network:40% per stay
Rehabilitation servicesOccupational therapy visit:
In-Network:$40
Out-of-Network:40%
Physical therapy and speech and language therapy visit:
In-Network:$40
Out-of-Network:40%
Ground ambulanceIn-Network:$250
Out-of-Network:$250
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:$50
Out-of-Network:40%
Routine foot care:
In-Network:$50
Out-of-Network:40%There may be limits on how much the plan will provide.
Medical equipment/suppliesDurable 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 drugsChemotherapy:
In-Network:20%
Out-of-Network:40%
Other Part B drugs:
In-Network:20%
Out-of-Network:40%

Benefits Services

Hearing
Hearing examIn-Network: $20
Out-of-Network: 40%
Fitting/evaluationNot covered
Hearing aids - inner earIn-Network: $380
Out-of-Network: $330-380
There may be limits on how much the plan will provide.
Hearing aids - outer earNot covered
Hearing aids - over the earIn-Network: $330
Out-of-Network: $330-380
There may be limits on how much the plan will provide.
Preventive Dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-ray(s)Not covered
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye examIn-Network: $0 copay
Out-of-Network: 40%
There may be limits on how much the plan will provide.
OtherNot covered
Contact lensesNot covered
Eyeglasses (frames and lenses)Not covered
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesNot covered

Coverage Area for AARP MedicareComplete Headwaters (PPO)

StateMinnesota
CountyRamsey

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$47 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$95 copayNot offered
Tier 5: Specialty TierNot offered25% 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$141 copay$131 copay
Tier 4: Non-Preferred Brand NameNot offered$285 copay$275 copay
Tier 5: Specialty TierNot offered25% coinsurance25% coinsurance

Physicians that accept AARP MedicareComplete Headwaters (PPO) for Minnesota

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Peter, Cermak
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Allison, Wong
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Amanda, Robotti
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Jonathon, Koverman
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Katherine, Kardell
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Laura, Kramer
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Leah, Gapinski
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Rahul, Kapur
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Will, Nicholson
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Louise, Mattson
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Curtis, Keller
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William, Roberts
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George, Smith
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Vicki, Barth
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Paokou, Yang
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Thomas, Lundsten
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John, Barsanti
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Angela, Smithson
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Jason, Devries
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Tara, Kelly
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Peter Cermak, M.D.
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  • Phone Number
    (651) 772-3461
  • Office Locations
    Ufp Phalen Village Clinic
    Saint Paul, MN 55106
Ufp Phalen Village Clinic Saint Paul MN, 55106
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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)