UnitedHealthcare Dual Complete (HMO SNP)

Medicare Advantage Plan for Nebraska

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH0169-3-0
CMS RatingNot Rated1
Plan TypeHMO 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
  • 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
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$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
$0 copay
Outpatient hospital coverage
$0 copay
Doctor visits
Primary:$0 copay
Specialist:$0 copay
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:$0 copay
Urgent care:$0 copay
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:$0 copay
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$0 copay
Outpatient x-rays:$0 copay
Mental health services
$0 copay
Outpatient group therapy visit with a psychiatrist:$0 copay
Outpatient individual therapy visit with a psychiatrist:$0 copay
Outpatient group therapy visit:$0 copay
Outpatient individual therapy visit:$0 copay
Skilled Nursing Facility
$0 copay
Rehabilitation services
Occupational therapy visit:$0 copay
Physical therapy and speech and language therapy visit:$0 copay
Ambulance
$0 copay
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:$0 copay
Routine foot care:$0
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):$0 copay
Prosthetics (e.g., braces, artificial limbs):$0 copay
Diabetes supplies:$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:$0 copay
Other Part B drugs:$0 copay

Coverage Area for UnitedHealthcare Dual Complete (HMO SNP)

StateNebraska
CountyDouglas

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$0 copayNot offered
Tier 2: Non-Preferred GenericNot offered$0 copayNot offered
Tier 3: Preferred Brand NameNot offered$0 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$0 copayNot offered
Tier 5: Specialty TierNot offered$0 copayNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$0 copayNot offered
Tier 2: Non-Preferred GenericNot offered$0 copayNot offered
Tier 3: Preferred Brand NameNot offered$0 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$0 copayNot offered
Tier 5: Specialty TierNot offered$0 copayNot offered

Physician Finder

Physicians that accept UnitedHealthcare Dual Complete (HMO SNP) for Nebraska

/
ZANONE, DANA
2734 N 61ST ST
OMAHA, NE 68104
TOUMEH, MOHAMED
5719 NW RADIAL HWY
OMAHA, NE 68104
YORK, GLENN
6069 MAPLE ST
OMAHA, NE 68104
PRICKETT, WESLEY
1513 N 60TH ST
OMAHA, NE 68104
HADDADIN, MAEN
2734 N 61ST ST
OMAHA, NE 68104
HATCHER, JEFFRY
2734 N 61ST ST
OMAHA, NE 68104
COTTON, THOMAS
5404 WESTERN AVE
OMAHA, NE 68132
BICHALA, SHALINI
5002 UNDERWOOD AVE
OMAHA, NE 68132
SAUER, TODD
702 N 58TH ST
OMAHA, NE 68132
SPECHT, PAT
119 N 51ST ST
OMAHA, NE 68132
MOORE, MICHAEL
119 N 51ST ST
OMAHA, NE 68132
KRATOCHVIL, JILLYN
119 N 51ST ST
OMAHA, NE 68132
LOUCKS, ERIN
119 N 51ST ST
OMAHA, NE 68132
FROCK, JAMES
7710 MERCY ROAD
OMAHA, NE 68132
IDE HELVIE, DANA
105 S 49TH ST
OMAHA, NE 68132
SHERRETS-RATIGAN, NOELLE
989400 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
DEVETTEN, MARCEL
988095 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
SIEBLER, JUSTIN
989265 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
BERTONI, JOHN
UNMC NEUROLOGY
OMAHA, NE 68198
BOCHKAREV, VICTOR
983280 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
SHILLCUTT, SASHA
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
UYSAL, UTKU
NEUROLOGICAL SCIENCES
OMAHA, NE 68198
Details
DANA ZANONE, M.D.
Phone Number
(402) 553-0222
Office Locations
2734 N 61ST ST
OMAHA, NE 68104
2734 N 61ST ST OMAHA NE, 68104

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