UnitedHealthcare Nursing Home 1 (PPO SNP)

Medicare Advantage Plan for Ohio

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH2406-1-0
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 $5,000 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$32.00
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:
$0Out-of-Network:
$0 copay
Diagnostic radiology services (e.g., MRI):In-Network:
0-20%Out-of-Network:
30%
Outpatient x-rays:In-Network:
$0Out-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 100Out-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:
$0Out-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 1 (PPO SNP)

StateOhio
CountyFranklin

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
Improving or maintaining physical health
Not Rated
Improving or maintaining mental health
Not Rated
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
Not Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Not Rated
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
Not Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Not Rated
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
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 UnitedHealthcare Nursing Home 1 (PPO SNP) for Ohio

/
CALLENDER, PATRICK
104 N MURRAY HILL RD
COLUMBUS, OH 43228
KING, GRETZEL
104 N MURRAY HILL RD
COLUMBUS, OH 43228
LUKEN, THERESA
4300 CLIME RD
COLUMBUS, OH 43228
MORRISON, KAREN
4171 ARLINGATE PLZ
COLUMBUS, OH 43228
KUPER, ALICIA
700 CHILDRENS DR
COLUMBUS, OH 43205
LEVIN, HOWARD
5131 BEACON HILL RD
COLUMBUS, OH 43228
CARINE, ALI
4310 CLIME RD
COLUMBUS, OH 43228
HANSEN, CECILIA
5100 W BROAD ST
COLUMBUS, OH 43228
FLYNN, KARYN
5212 W BROAD ST
COLUMBUS, OH 43228
LAMPL, BROOKE
5100 W BROAD ST
COLUMBUS, OH 43228
KNOPP, JAMES
5100 W BROAD ST
COLUMBUS, OH 43228
CASTLE, LINDSAY
217 HARRISBURG AVE
LANCASTER, PA 17603
HINCKLEY, JOHN
5100 W BROAD ST
COLUMBUS, OH 43228
VINCENT, KAREN
5100 W BROAD ST
COLUMBUS, OH 43228
BOWERS, STUART
5141 W BROAD ST
COLUMBUS, OH 43228
LEVIN, SETH
5131 BEACON HILL RD
COLUMBUS, OH 43228
CUNAGIN, KIMBERLY
5100 W BROAD ST
COLUMBUS, OH 43228
MILLER, CAREN
5100 W BROAD ST
COLUMBUS, OH 43228
JORDAN, KEVIN
5100 W BROAD ST
COLUMBUS, OH 43228
FRASER, WILLIAM
5100 W BROAD ST
COLUMBUS, OH 43228
RYBALTOWSKI, MARIUSZ
5100 W BROAD ST
COLUMBUS, OH 43228
PARKER, SARAH
5100 W BROAD ST
COLUMBUS, OH 43228
HARRIS, PAUL
5193 W BROAD ST
COLUMBUS, OH 43228
JONES, BRUCE
5100 W BROAD ST
COLUMBUS, OH 43228
Details
PATRICK CALLENDER, DO
Phone Number
(614) 878-6413
Office Locations
104 N MURRAY HILL RD
COLUMBUS, OH 43228
104 N MURRAY HILL RD COLUMBUS OH, 43228

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