2018 UnitedHealthcare Nursing Home Plan 1 (PPO SNP) H2228-2-0 in RI from UnitedHealthcare | HealthPocket

UnitedHealthcare Nursing Home 1 (PPO SNP)

Medicare Advantage Plan for Rhode Island

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH2228-2-0
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 $6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$30.10
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:
$0
Out-of-Network:
$0 copay
Diagnostic radiology services (e.g., MRI):
In-Network:
0-20%
Out-of-Network:
30%
Outpatient x-rays:
In-Network:
$0
Out-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 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:
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:
$0
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:
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)

StateRhode Island
CountyProvidence

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
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
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

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
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 Rhode Island

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KHATIB, PERVEZ
100 CURTIS ST
PROVIDENCE, RI 02909
SALAK, JESSICA
100 CURTIS ST
PROVIDENCE, RI 02909
MASTROSTEFANO, PASQUALE
347 BROADWAY
PROVIDENCE, RI 02909
NG, KAREN
100 CURTIS ST
PROVIDENCE, RI 02909
GURNEY, ELLEN
239 CRANSTON ST.
PROVIDENCE, RI 02907
ZITER, JEANNE
21 PEACE ST
PROVIDENCE, RI 02907
CECE, JOHN
230 RESERVOIR AVE
PROVIDENCE, RI 02907
MUKAND, JON
21 PEACE ST
PROVIDENCE, RI 02907
PATEL, SONAL
239 CRANSTON ST
PROVIDENCE, RI 02907
ABEJUELA, MARIE
21 PEACE ST
PROVIDENCE, RI 02907
SKURKOVICH, BORIS
239 CRANSTON ST
PROVIDENCE, RI 02907
HOLLINGER, WALTER
21 PEACE ST
PROVIDENCE, RI 02907
THOMAS, LONICE
100 CURTIS ST
PROVIDENCE, RI 02909
TAMAN, MAGED
21 PEACE STREET
PROVIDENCE, RI 02907
RODRIGUEZ-PERIS, EMILIO
655 BROAD STREET
PROVIDENCE, RI 02907
SCOTT, WALTER
655 BROAD ST
PROVIDENCE, RI 02907
BURKE, ROBERT
239 CRANSTON ST
PROVIDENCE, RI 02907
UROLOGIC SURGEONS OF NEW ENGLAND, P.C.
125 CORLISS ST
PROVIDENCE, RI 02904
Details
PERVEZ KHATIB, MD
Phone Number
(401) 444-0540
Office Locations
100 CURTIS ST
PROVIDENCE, RI 02909
100 CURTIS ST PROVIDENCE RI, 02909

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