AARP MedicareComplete Choice 1 (PPO)

Medicare Advantage Plan for West Virginia

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUnitedHealthcare
Plan IDH8211-1-0
CMS RatingNot Rated1
Plan TypePPO
Annual Deductible$300.00

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
$34.20
Monthly Health Plan Premium
$8.80

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$295 for days 1 through 6
$0 for days 7 through 90
$0 for days 91 and beyond
Out-of-Network:
40% per stay
Outpatient hospital coverage
In-Network:
$295 per visit. Out-of-Network:
40% per visit
Doctor visits
Primary:In-Network:
$15 per visit. Out-of-Network:
$40-70 per visit
Specialist:In-Network:
$45 per visit. Out-of-Network:
$70 per visit
Preventive care
In-Network:
$0 copay. Out-of-Network:
0-40%
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:
$10-21 or 40%
Lab services:In-Network:
$10Out-of-Network:
$10-21 or 40%
Diagnostic radiology services (e.g., MRI):In-Network:
20%Out-of-Network:
$10-21 or 40%
Outpatient x-rays:In-Network:
$14Out-of-Network:
$10-21 or 40%
Mental health services
In-Network:
$295 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
40% per stay
Outpatient group therapy visit with a psychiatrist:In-Network:
$30Out-of-Network:
$35-45
Outpatient individual therapy visit with a psychiatrist:In-Network:
$40Out-of-Network:
$35-45
Outpatient group therapy visit:In-Network:
$30Out-of-Network:
$35-45
Outpatient individual therapy visit:In-Network:
$40Out-of-Network:
$35-45
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$160 for days 21 through 62
$0 for days 63 through 100
Out-of-Network:
40% per stay
Rehabilitation services
Occupational therapy visit:In-Network:
$40Out-of-Network:
$70
Physical therapy and speech and language therapy visit:In-Network:
$40Out-of-Network:
$70
Ambulance
In-Network:
$250Out-of-Network:
$250
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:In-Network:
$45Out-of-Network:
$70
Routine foot care:In-Network:
$45Out-of-Network:
$70
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):In-Network:
20% per item. Out-of-Network:
50% per item
Prosthetics (e.g., braces, artificial limbs):In-Network:
20% per item. Out-of-Network:
40% per item
Diabetes supplies:In-Network:
$0 per item. Out-of-Network:
40% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:In-Network:
20%Out-of-Network:
40%
Other Part B drugs:In-Network:
20%Out-of-Network:
40%

Coverage Area for AARP MedicareComplete Choice 1 (PPO)

StateWest Virginia
CountyKanawha

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 offered27% 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 offered27% coinsurance27% coinsurance

Physician Finder

Physicians that accept AARP MedicareComplete Choice 1 (PPO) for West Virginia

/
HANSBARGER, LUTHER
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
MATUSIC, JOSEPH
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
CALHOUN, BYRON
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
EWING, KIMBERLY
800 PENNSYLVANIA AVE
CHARLESTON, WV 25302
VERMA, PURUSHOTTAM
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
JOSHI, ANIKET
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
HUNTER, PAUL
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
UPTON, SUE
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
SKINNER, LISA
830 PENNSLYVANIA AVE
CHARLESTON, WV 25302
CHAUVENET, ALLEN
830 PENNSYLVANIA AVENUE
CHARLESTON, WV 25302
CHEBIB, MOUNA
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
GRODMAN, HOWARD
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
BENDRE, SACHIN
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
SUSON, EDUARDO
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
EVANS, CORTNEY
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
PARRY, AARON
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
ECKERD, JOHN
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
DAVIS, JENNIFER
318 LEE ST W STE 201
CHARLESTON, WV 25302
BUSH, STEPHEN
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
KHAN, RAHEEL
830 PENNSYLVANIA AVE STE 104
CHARLESTON, WV 25302
CHIANG, MYRA
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
HUNTER, FRANCIS
12 KANAWHA TER
SAINT ALBANS, WV 25177
THOMAS, DAVID
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
Details
LUTHER HANSBARGER, M.D.
Phone Number
(304) 388-1552
Office Locations
830 PENNSYLVANIA AVE
CHARLESTON, WV 25302
830 PENNSYLVANIA AVE CHARLESTON WV, 25302

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