2019 AARP MedicareComplete Plan 2 (HMO) H3805-013-000 in OR from UnitedHealthcare | HealthPocket

AARP MedicareComplete Plan 2 (HMO)

$0/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH3805-013-000
Plan Year2019
CMS Rating
Plan TypeHMO
Annual Deductible$245.00
Out-of-Pocket Maximum4100

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
  • was the best selling plan in Multnomah in 2021

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$0.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$4,100 In-network
Optional Supplemental BenefitsYes

Benefits

SERVICECOST
Inpatient hospital coverage$425 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
Outpatient hospital coverage$350 per visit
Doctor visitsPrimary:$5 per visit
Specialist:$40 per visit
Preventive care$0 copay
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:20%
Lab services:$0
Diagnostic radiology services (e.g., MRI):20%
Outpatient x-rays:$14
Mental health servicesInpatient hospital - psychiatric:$425 per day for days 1 through 3
$0 per day for days 4 through 90
Outpatient group therapy visit with a psychiatrist:$30
Outpatient individual therapy visit with a psychiatrist:$40
Outpatient group therapy visit:$30
Outpatient individual therapy visit:$40
Skilled Nursing Facility$0 per day for days 1 through 20
$160 per day for days 21 through 46
$0 per day for days 47 through 100
Rehabilitation servicesOccupational therapy visit:$40
Physical therapy and speech and language therapy visit:$40
Ground ambulance$250
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:$40
Routine foot care:$40There may be limits on how much the plan will provide.
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:$0 per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:20%
Other Part B drugs:20%

Benefits Services

Hearing
Hearing exam$5
Fitting/evaluationNot covered
Hearing aids - inner ear$380There may be limits on how much the plan will provide.
Hearing aids - outer earNot covered
Hearing aids - over the ear$330There 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 exam$20There may be limits on how much the plan will provide.
OtherNot covered
Contact lenses$0 copay. There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)Not covered
Eyeglass frames$0 copay. There may be limits on how much the plan will provide.
Eyeglass lenses$0 copay. There may be limits on how much the plan will provide.
UpgradesNot covered

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$3 copayNot offered
Tier 2: GenericNot offereds$12 copayNot offered
Tier 3: Preferred BrandNot offereds$47 copayNot offered
Tier 4: Non-Preferred DrugNot offereds$100 copayNot offered
Tier 5: Specialty TierNot offereds28% coinsuranceNot offered

90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$9 copay$0 copay
Tier 2: GenericNot offereds$36 copay$24 copay
Tier 3: Preferred BrandNot offereds$141 copay$131 copay
Tier 4: Non-Preferred DrugNot offereds$300 copay$290 copay
Tier 5: Specialty TierNot offereds28% coinsurance28% coinsurance

Physicians that accept AARP MedicareComplete 2 (HMO) for Oregon

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Marilyn, Webber
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Gary, Geddes
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Cynthia, Romero
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Morganann, Parker
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Joshua, Raj
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Lopa, Dalmia
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Roxana, Abbott
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Stacy, Reed
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Heather, Larson
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Maureen, Mays
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Lydia, Chiang
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Frank, Barich
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Swati, Kakodkar
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Jane, Kimhoffman
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Angeles, Pena
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Marlo, Mcilraith
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Brian, Paskowski
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Addison, Wilson
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Gunjeet, Samagh
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Michael, Deegan
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Harold, Barry
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Vic, Krisciunas
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Marilyn Webber, M.D.
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  • Phone Number
    (503) 629-0237
  • Office Locations
    14223 Nw Spruceridge Ln
    Portland, OR 97229
14223 Nw Spruceridge Ln Portland OR, 97229
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HealthPocket.com is a free information source. 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. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. While on our site, if you click on a plan or link, you may be directed to one of our partners who offers health insurance products. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.