AARP MedicareComplete 1 (HMO)

Medicare Advantage Plan for Washington

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH3805-14-0
CMS Rating1
Plan TypeHMO
Annual Deductible$185.00

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
Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$4,200 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$33.10
Monthly Health Plan Premium
$52.90

Benefits

Service
Cost
Inpatient hospital coverage
$250 for days 1 through 7
$0 for days 8 through 90
$0 for days 91 and beyond
Outpatient hospital coverage
$245 per visit
Doctor visits
Primary:
$5 per visit
Specialist:
$35 per visit
Preventive care
$0 copay
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:
20%
Lab services:
$0
Diagnostic radiology services (e.g., MRI):
20%
Outpatient x-rays:
$14
Mental health services
$250 for days 1 through 6
$0 for days 7 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 for days 1 through 20
$160 for days 21 through 47
$0 for days 48 through 100
Rehabilitation services
Occupational therapy visit:
$35
Physical therapy and speech and language therapy visit:
$35
Ambulance
$250
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
$35
Routine foot care:
$35
Medical equipment/supplies
Durable 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 drugs
Chemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for AARP MedicareComplete 1 (HMO)

StateWashington
CountyKing

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$3 copayNot offered
Tier 2: Non-Preferred GenericNot offered$12 copayNot offered
Tier 3: Preferred Brand NameNot offered$45 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$95 copayNot offered
Tier 5: Specialty TierNot offered29% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$9 copay$0 copay
Tier 2: Non-Preferred GenericNot offered$36 copay$0 copay
Tier 3: Preferred Brand NameNot offered$135 copay$125 copay
Tier 4: Non-Preferred Brand NameNot offered$285 copay$275 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
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Not Rated
Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
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 AARP MedicareComplete 1 (HMO) for Washington

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BALOGUN, ANIFAT
6850 35TH AVE NE
SEATTLE, WA 98115
GLOBERMAN, STACY
9800 4TH AVE NE
SEATTLE, WA 98115
TRAN, THAO
9725 3RD AVE NE STE 500
SEATTLE, WA 98115
SCARPELLO, KATHLEEN
402 NE 72ND ST STE 2
SEATTLE, WA 98115
GARDEY, TAKLA
6300 9TH AVE NE
SEATTLE, WA 98115
MAURI, KERRY
9725 3RD AVE NE
SEATTLE, WA 98115
GALLOWAY, KAYLA
460 NE 70TH STREET
SEATTLE, WA 98115
LONDERGAN, JULIE
2705 NE 65TH ST
SEATTLE, WA 98115
FOSTER, MARIA
6300 9TH AVE NE STE 106
SEATTLE, WA 98115
JACOBSEN, CARISSA
460 NE 70TH STREET
SEATTLE, WA 98115
HEALY, PATRICIA
460 NE 70TH ST
SEATTLE, WA 98115
WILLIAMS, CHRISTOPHER
2021 NE 90TH ST
SEATTLE, WA 98115
NEWELL, STANLEY
9501 5TH AVE NE
SEATTLE, WA 98115
MCCORMACK, ANNE
6823 19TH AVE NE
SEATTLE, WA 98115
COLVEN, ROY
325 9TH AVE, DERMATOLOGY SECTION
SEATTLE, WA 98115
SIMONS, BART
7209 WOODLAWN AVE NE
SEATTLE, WA 98115
MOULTON, ROCKWELL
7301 45TH AVE NE
SEATTLE, WA 98115
TILLES, STEPHEN
9725 3RD AVE NE STE 500
SEATTLE, WA 98115
KANTOR, STANLEY
9208 ROOSEVELT WAY NE
SEATTLE, WA 98115
LILJA, ERIK
9501 5TH AVE NE
SEATTLE, WA 98115
NAIMI, DAVID
9725 3RD AVE NE STE 500
SEATTLE, WA 98115
SMITH, CATHERINE
7210 ROOSEVELT WAY NE
SEATTLE, WA 98115
SHAMSELDIN, SHANNON
7210 ROOSEVELT WAY NE
SEATTLE, WA 98115
SHAMSELDIN, MICHAEL
7210 ROOSEVELT WAY NE
SEATTLE, WA 98115
Details
ANIFAT BALOGUN, MD
Phone Number
(206) 525-0903
Office Locations
6850 35TH AVE NE
SEATTLE, WA 98115
6850 35TH AVE NE SEATTLE WA, 98115

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