UnitedHealthcare Assisted Living 2 (PPO SNP)

Medicare Advantage Plan for Oregon

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH0710-37-0
CMS Rating1
Plan TypePPO SNP
Annual Deductible$200.00

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 $3,500 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$28.70
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$250 for days 1 through 7
$0 for days 8 through 90
$0 for days 91 and beyond
Out-of-Network:
30% per stay
Outpatient hospital coverage
In-Network:
$250 per visit
Out-of-Network:
30% per visit
Doctor visits
Primary:
In-Network:
$0 copay
Out-of-Network:
30% per visit
Specialist:
In-Network:
$30 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:
$30-40 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
20%
Out-of-Network:
30%
Lab services:
In-Network:
$0
Out-of-Network:
$0 copay
Diagnostic radiology services (e.g., MRI):
In-Network:
20%
Out-of-Network:
30%
Outpatient x-rays:
In-Network:
$0
Out-of-Network:
30%
Mental health services
In-Network:
$250 for days 1 through 6
$0 for days 7 through 90
Out-of-Network:
30% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$30
Out-of-Network:
30%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
30%
Outpatient group therapy visit:
In-Network:
$30
Out-of-Network:
30%
Outpatient individual therapy visit:
In-Network:
$40
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:
$100
Out-of-Network:
$100
Transportation
In-Network:
$0 copay
Out-of-Network:
75%
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$0 copay
Out-of-Network:
30%
Routine foot care:
In-Network:
$0 copay
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:
$0 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 Assisted Living 2 (PPO SNP)

StateOregon
CountyMultnomah

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$2 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$100 copayNot offered
Tier 5: Specialty TierNot offered29% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$6 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$300 copay$290 copay
Tier 5: Specialty TierNot offered29% coinsurance29% coinsurance

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 Assisted Living 2 (PPO SNP) for Oregon

/
SAMAGH, GUNJEET
15640 NW LAIDLAW RD
PORTLAND, OR 97229
CRIHFIELD, KIMBERLY
15285 NW CENTRAL DR
PORTLAND, OR 97229
KAKODKAR, SWATI
15640 NW LAIDLAW RD
PORTLAND, OR 97229
BARICH, FRANK
15640 NW LAIDLAW RD
PORTLAND, OR 97229
ROMERO, CYNTHIA
14600 NW CORNELL RD
PORTLAND, OR 97229
DEEGAN, MICHAEL
4876 NW BETHANY BLVD
PORTLAND, OR 97229
JI, DONG
15640 NW LAIDLAW RD
PORTLAND, OR 97229
GILLINGHAM, TODD
15160 NW LAIDLAW RD
PORTLAND, OR 97229
BARRY, HAROLD
12400 NW CORNELL RD
PORTLAND, OR 97229
PENA, ANGELES
15220 NW LAIDLAW RD STE 100
PORTLAND, OR 97229
BARLOW, ROBERT
12400 NW CORNELL RD
PORTLAND, OR 97229
LARSON, HEATHER
2127 NW MILLER RD.
PORTLAND, OR 97229
GRAHAM, BARBARA
12672 NW BARNES RD
PORTLAND, OR 97229
GEDDES, GARY
12400 NW CORNELL RD
PORTLAND, OR 97229
KRISCIUNAS, VIC
12400 NW CORNELL RD
PORTLAND, OR 97229
LUTFI, EMAN
9555 SW BARNES RD
PORTLAND, OR 97229
DOSHI, HEENA
12400 NW CORNELL RD
PORTLAND, OR 97229
KIMHOFFMAN, JANE
15220 NW LAIDLAW RD
PORTLAND, OR 97229
MCILRAITH, MARLO
15220 NW LAIDLAW RD STE 100
PORTLAND, OR 97229
WILSON, ADDISON
15285 NW CENTRAL DR
PORTLAND, OR 97229
DALMIA, LOPA
12400 NW CORNELL RD STE 201
PORTLAND, OR 97229
HANKENSON, LORI
9555 SW BARNES RD
PORTLAND, OR 97229
CHIANG, LYDIA
15220 NW LAIDLAW RD., STE 100
PORTLAND, OR 97229
ABBOTT, ROXANA
15640 NW LAIDLAW RD
PORTLAND, OR 97229
Details
GUNJEET SAMAGH, MD
Phone Number
(503) 764-0100
Office Locations
15640 NW LAIDLAW RD
PORTLAND, OR 97229
15640 NW LAIDLAW RD PORTLAND OR, 97229

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