UHC MedicareMax Medicare Advantage FL-0028 (HMO)

Inpatient Hospital See details

Inpatient Hospital services, including acute and psychiatric, are covered under the UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan. For Inpatient Hospital-Acute, there is no copay for a Medicare-covered stay, and additional days (91-999) also have no copay; however, non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, there is also no copay, but additional days and non-Medicare-covered stays are not covered.

Outpatient Services See details

Outpatient services include outpatient hospital services with a copay between $0 and $150, observation services with a $150 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with no copay for individual and group sessions, and outpatient blood services with no copay.

Partial Hospitalization See details

Partial Hospitalization is covered by the UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan, but requires prior authorization. The copay for this benefit is $55.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $150 copay, while transportation services to a plan-approved health-related location have no copay for up to 60 one-way trips per year via taxi or medical transport. Transportation services to any other health-related location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services, the copay is $140, and there is no coinsurance. Urgently Needed Services has no copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.

Primary Care See details

Primary Care includes coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Chiropractic Services do not cover routine care, and Routine Foot Care has a limit of 6 visits per year.

Preventive Services See details

The UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan covers preventive services with no copay for annual physical exams. Additional preventive services, including Fitness Benefit and Home and Bathroom Safety Devices and Modifications, are covered with a $0 copay, while services like Health Education, In-Home Safety Assessments, and others are not covered.

Hearing Services See details

Hearing exams are covered with no copay. Routine hearing exams are covered with no copay, while fitting/evaluation for hearing aids are not covered. Prescription hearing aids are partially covered, with copays ranging from $199 to $1249 for all types of hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered with a copay of $99-$829.

Vision Services See details

The UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan covers vision services, including eye exams and eyewear with no copay. Eyeglass lenses and frames are not covered, but contact lenses, eyeglasses (lenses and frames), and upgrades are covered with a $0 copay. The plan offers a combined maximum benefit of $300 per year for eyewear.

Dental Services See details

Dental services include oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, prosthodontics (removable), and oral and maxillofacial surgery with no copay, but adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. Orthodontic services are covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered by the UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan, with a $35 copay for Medicare Part B Insulin Drugs, and a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs, Other Medicare Part B Drugs, and Medicare Part B Insulin Drugs. Prior authorization is required.

Dialysis Services See details

Dialysis Services are covered, with a coinsurance of 20%. Prior authorization is required.

Medical Equipment See details

The UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan covers medical equipment, including Durable Medical Equipment (DME) with no coinsurance and no copay, as well as Prosthetics/Medical Supplies with coinsurance for Medicare-covered supplies and copays for Medicare-covered prosthetic devices. Diabetic equipment is also covered, with coinsurance for Medicare-covered diabetic supplies and copays for diabetic therapeutic shoes/inserts, with prior authorization required.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, Diagnostic Radiological Services with no copay, Therapeutic Radiological Services with a 20% coinsurance, and Outpatient X-Ray Services with no copay. Prior authorization is required for all diagnostic and radiological services.

Home Health Services See details

Home Health Services are covered by the UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You'll pay no copay for days 1-20, and a $203 copay for days 21-100.

Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.

Other Services See details

The UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan covers Over-the-Counter (OTC) Items and Meal Benefits. OTC items have no copay, while meal benefits also have no copay and require prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.