UnitedHealth Group, Inc.
Plan ID: H2001-41-0
2025 UHC Dual Complete MT-S001 (PPO D-SNP) H2001 — 041 — 0 is a Medicare Advantage plan with drug coverage. It has received a 4-out-of-5 star rating from CMS for 2025.
Learn more about UHC Dual Complete MT-S001 (PPO D-SNP) H2001 - 041 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.
4 / 5 stars for 2025
$50.60 /mo
Monthly premium
$590.00
Drug deductible
$14000.00
Out-of-pocket maximum (Combined)
Enroll online
Call to enroll
OR
Get personalized help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week!
2025 UHC Dual Complete MT-S001 (PPO D-SNP) H2001 — 041 — 0 is a PPO D-SNP offered in Select Counties in Montana by UnitedHealth Group, Inc.. It has a monthly premium of $50.60 and includes a Part B premium discount of $1.60.
Important:
2025 UHC Dual Complete MT-S001 (PPO D-SNP) H2001 — 041 — 0 is a Dual-Eligible Special Needs Type plan. You can only enroll in this plan if you meet specific criteria.
Standard Part B Premium
$185.00
Part B premium reduction
- $1.60
Monthly Plan Premium
$50.60
Total Premium:
$234.00
Note:
The standard Medicare Part B premium for 2025 is $185.00. Your premium may differ based on factors like late enrollment, income (IRMAA), or disability status. Most people enrolled in Medicare Part B are required to pay this premium.
Special needs plan type
Yes
Out-of-pocket maximum (In-Network)
N/A
Out-of-pocket maximum (Out-of-Network)
$9350.00
Out-of-pocket maximum (Combined)
$14000.00
Conditions Covered
None
Plan Organization:
UnitedHealth Group, Inc.
Plan Type:
PPO D-SNP
Location:
Select Counties in Montana
Drugs Covered:
Yes
Drug Formulary:
Pharmacies:
Doctors Link:
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Drug deductible
$590
Note:
This plan does not charge an annual deductible for all drugs. The $590.00 annual deductible only applies to drugs in certain tiers.
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
UHC Dual Complete MT-S001 (PPO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Benefit Type
Defined Standard
Prescription drug deductible
$590.00
This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.
Part D | LIS Full |
---|---|
$50.60 | $50.60 |
After you pay your $590.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2000.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Preferred Pharmacy | Standard Pharmacy | Preferred Mail | Standard Mail |
---|---|---|---|---|
1. Preferred Generic | - | - | - | - |
2. Standard Generic | - | - | - | - |
3. Preferred Brand | - | - | - | - |
4. Non-Preferred Drug | - | - | - | - |
5. Specialty Tier | - | - | - | - |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
UHC Dual Complete MT-S001 (PPO D-SNP) also provides the following benefits.
Hearing Services benefits are covered.
Hearing Exams benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
Cost Sharing:
More Details:
Which Hearing Exam Benefits have a Coinsurance
Routine Hearing Exams
Minimum coinsurance
20
Which Hearing Exam Benefits have a Copayment
Fitting/Evaluation for Hearing Aid
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
No
Routine Hearing Exams benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
1
Periodicity
Every year
Minimum copayment
0.00
Maximum copayment
0.00
Not covered.
Prescription Hearing Aids benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
Cost Sharing:
More Details:
Service maximum plan benefit coverage
Yes
Select Coverage
Both ears combined
Maximum plan benefit coverage type
Plan-specified amount per period
Does the maximum plan benefit coverage amount apply to in-network services only or does it apply to both in-network and out-of-network services
Both In-network and Out-of-network services
Maximum amount
2200.00
Periodicity
Every year
Prescription Hearing Aids (all types) benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
2
Periodicity
Every year
Minimum copayment
0.00
Maximum copayment
0.00
Not covered.
Not covered.
Not covered.
OTC Hearing Aids benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Quantity for Hearing Aids
2
Periodicity
Every year
Is there a maximum plan benefit coverage?
No
Vision Services benefits are covered.
Eye Exams benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
Cost Sharing:
More Details:
Which Eye Exams have a Copayment
Routine Eye Exams, Other
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
No
Routine Eye Exams benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
1
Periodicity
Every year
Eyewear benefits are covered – including services not usually covered by Medicare plans.
Cost Sharing:
More Details:
Which Eyewear Benefits have a Copayment
Contact lenses, Eyeglasses (lenses and frames), Eyeglass frames, Upgrades
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
Yes
Does the Maximum Plan Benefit Coverage amount apply to In-network services only OR does it apply to both In-network and Out-of-network services?
Both In-network and Out-of-network services
Maximum plan benefit coverage type
Plan-specified amount per period
Do you offer a Combined Max Plan Benefit Coverage Amount for all Eyewear?
Yes
Combined maximum amount
350.00
Periodicity
Every year
Contact Lenses benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
Yes
Not covered.
Eyeglass lenses benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No, indicate number
Number of pairs
1
Periodicity
Every year
Eyeglass frames benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No, indicate number
Number of eyeglass frames
1
Periodicity
Every year
Not covered.
Dental Services benefits are covered.
Medicare Dental Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Coinsurance percentage
20
Other Dental Services benefits are covered.
More Details:
Which combination of services are included in a single cost per office visit
Which combination of services are included in a single cost per office visit
Is there a maximum plan benefit coverage?
Yes
Does the maximum plan benefit coverage amount apply to in-network services only or does it apply to both in-network and out-of-network services
Both in-network and out-of-network services
Maximum amount
2000.00
Periodicity
Every year
Oral Exams benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Periodicity varies by service ranging from 2 every year to 1 every 3 years.
Dental X-Rays benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of X-Rays
1
Periodicity
Other, Describe
Description
Periodicity varies by service ranging from 1 per 60 floating months to 8 every year.
Other Diagnostic Dental Services benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Periodicity varies by service ranging from 1 per floating 60 months to 1 per floating day.
Prophylaxis (Cleaning) benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
2
Periodicity
Every year
Fluoride Treatment benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
2
Periodicity
Every year
Other Preventive Dental Services benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Periodicity varies by service ranging from 1 per floating 36 months to 2 per floating 12 months.
Orthodontic Services benefits are covered.
More Details:
Is there a maximum plan benefit coverage?
Yes
Maximum plan benefit coverage type
Covered under Diagnostic and Preventive Dental (16b)
Restorative Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Periodicity varies by service ranging from 1 per lifetime to unlimited.
Adjunctive General Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Periodicity varies by service ranging from 1 per plan year to unlimited.
Endodontics benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Periodicity varies by service ranging from 1 per lifetime to unlimited.
Periodontics benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Periodicity varies by service ranging from 1 per lifetime to 4 per year.
Prosthodontics, removable benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Periodicity varies by service ranging from 1 per lifetime to 2 per year.
Maxillofacial Prosthetics benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Periodicity varies by service ranging from 1 per floating 60 months to unlimited.
Not covered.
Prosthodontics, fixed benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Recement or re-bond fixed partial denture: 1 per year Fixed partial denture repair: 1 per floating 24 months All other services: 1 every 5 years
Oral and Maxillofacial Surgery benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Other, Describe
Description
Periodicity varies by service ranging from 1 per lifetime to unlimited.
Not covered.
Home Infusion bundled Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Medicare Part B Rx Drugs have a Coinsurance
Medicare Part B Chemotherapy/Radiation Drugs, Other Medicare Part B Drugs
Does this plan have a service specific maximum enrollee out-of-pocket cost (MOOP)?
No
Does the plan offer step therapy?
Yes
Does the benefit step from?
Part B to Part B, Part B to Part D
Does the plan provide Part D home infusion drugs as part of a bundled service as a mandatory supplemental benefit?
No
Insulin benefits are covered.
Medicare Part B Insulin Drugs benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Does the Part B drugs - Insulin cost sharing count towards any plan-level deductible?
No
Medicare Part B Chemotherapy/Radiation Drugs benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Other Medicare Part B Drugs benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Preventive Services benefits are covered.
Medicare-covered Zero Dollar Preventive Services benefits are covered.
Annual Physical Exam benefits are covered – including services not usually covered by Medicare plans.
Cost Sharing:
More Details:
Is there a maximum plan benefit coverage amount?
No
Additional Preventive Services benefits are covered – including services not usually covered by Medicare plans.
Cost Sharing:
More Details:
Which Other Defined Supplemental Benefits have a Copayment
14c4: Fitness Benefit*, 14c8: Home and Bathroom Safety Devices and Modifications*
Is there a service-specific Maximum Plan Benefit Coverage amount for Other Defined Supplemental Benefits?
No
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Fitness Benefit benefits are covered.
More Details:
Type of Fitness Benefit offered
Memory Fitness, Activity Tracker
Minimum copayment
0.00
Maximum copayment
0.00
Not covered.
Not covered.
Not covered.
Home and Bathroom Safety Devices and Modifications benefits are covered.
More Details:
Maximum copayment
0.00
Minimum copayment
0.00
Not covered.
Kidney Disease Education Services benefits are covered.
Cost Sharing:
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Other Preventive Services benefits are covered.
Cost Sharing:
More Details:
Which Services have a Coinsurance
Medicare-covered Glaucoma Screening, Medicare-covered EKG following Welcome Visit
Which Services have a Copayment
Medicare-covered Diabetes Self-Management Training, Medicare-covered Barium Enemas, Medicare-covered Digital Rectal Exams
Is a referral required for any Services?
No
Glaucoma Screening benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Diabetes Self-Management Training benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Barium Enemas benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Digital Rectal Exams benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
EKG following Welcome Visit benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Other Services benefits are covered.
Not covered.
Over-the-Counter (OTC) Items benefits are covered.
Cost Sharing:
More Details:
Does the plan provide Over-The-Counter (OTC) Items as a supplemental benefit under Part C?
Yes
Is there a maximum plan benefit coverage amount?
No
Plan offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit?
Yes
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
Plan offers Naloxone coverage as a Part C OTC benefit?
Yes
Does this cover all of the drugs on the CMS OTC list which may be found in Chapter 4 of the Medicare Managed Care Manual
No
Meal Benefit benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Does the plan provide a limited duration Meal Benefit as a supplemental benefit under Part C? Note: Only primarily health-related meals offered in accordance with Chapter 4 of the MMCM should be entered in this section.
Yes
Type of primarily health related meals benefit offered
For a chronic illness
Is there a maximum plan benefit coverage amount?
No
Not covered.
Other Services benefits are covered.
More Details:
Is Authorization required for one or more Additional Services?
No
Is a referral required for one or more Additional Services?
No
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Dialysis Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Medical Equipment benefits are covered.
Durable Medical Equipment (DME) benefits are covered.
More Details:
Is there a coinsurance?
Yes
Minimum coinsurance
15
Maximum coinsurance
15
Is there a copayment ?
No
Are there preferred vendors/manufacturers for Durable Medical Equipment (DME)?
No
Authorization required for this benefit?
Yes
Not covered.
Prosthetics/Medical Supplies - Non-Medicare benefit benefits are covered.
More Details:
Is there a coinsurance?
Yes
Which Prosthetics/Medical Supplies have a Coinsurance
Medicare-covered Prosthetic Devices, Medicare-covered Medical Supplies
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Prosthetic Devices benefits are covered.
More Details:
Minimum coinsurance
15
Maximum coinsurance
15
Medical Supplies benefits are covered.
Cost Sharing:
Diabetic Equipment benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Diabetic Supplies and Services have a Coinsurance
Medicare-covered Diabetic Supplies
Which Diabetic Supplies and Services have a Copayment
Medicare-covered Diabetic Therapeutic Shoes or Inserts
Do you limit Diabetic supplies and services to those from specified manufacturers
Yes
Diabetic Supplies benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Diabetic Therapeutic Shoes/Inserts benefits are covered.
More Details:
Minimum coinsurance
15
Maximum coinsurance
15
Ambulance and Transportation Services benefits are covered.
All Ambulance Services benefits are covered. Prior Authorization is required.
More Details:
Is there a coinsurance?
Yes
Which Services have a Coinsurance
Medicare-covered Ground Ambulance Services, Medicare-covered Air Ambulance Services
Is this Coinsurance waived if admitted to hospital?
No
Is there a copayment ?
No
Ground Ambulance Services benefits are covered.
Cost Sharing:
Air Ambulance Services benefits are covered.
Cost Sharing:
Transportation Services benefits are covered.
Not covered.
Not covered.
Outpatient Services benefits are covered.
All Outpatient Hospital Services benefits are covered.
Cost Sharing:
More Details:
Which Services have a Coinsurance
Medicare-covered Outpatient Hospital Services, Medicare-covered Observation Services
Outpatient Hospital Services benefits are covered. Prior Authorization is required.
Cost Sharing:
Observation Services benefits are covered. Prior Authorization is required.
Cost Sharing:
Ambulatory Surgical Center (ASC) Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Outpatient Substance Abuse Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Outpatient Substance Abuse services have a Coinsurance
Medicare-covered Individual Sessions, Medicare-covered Group Sessions
Individual Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Group Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Outpatient Blood Services benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
Cost Sharing:
More Details:
Enhanced benefit
Three (3) Pint Deductible Waived
Diagnostic and Radiological Services benefits are covered.
All Diagnostic services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Outpatient Diagnostic Procedures/Tests/Lab Services have a Coinsurance
Medicare-covered Lab Services
Is there a copayment?
Yes
Which Outpatient Diagnostic Procedures/Tests/Lab Services have a Copayment
Medicare-covered Diagnostic Procedures/Tests
If a member receives multiple services at the same location on the same day, does only the maximum copay apply?
No
Diagnostic Procedures/Tests benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Lab Services benefits are covered.
Cost Sharing:
All Radiological Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Outpatient Diagnostic/Therapeutic Radiological Services have a Coinsurance
Medicare-covered Diagnostic Radiological Services, Medicare-covered Therapeutic Radiological Services, Medicare-covered X-Ray Services
Is there a copayment?
No
Diagnostic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
0
Therapeutic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Outpatient X-Ray Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Primary Care benefits are covered.
Primary Care Physician Services benefits are covered.
Cost Sharing:
Chiropractic Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Chiropractic Services have a Coinsurance
Routine Care
Not covered.
Occupational Therapy Services benefits are covered.
More Details:
Is there a coinsurance?
Yes
Minimum coinsurance
0
Maximum coinsurance
20
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
No
Physician Specialist Services benefits are covered. Prior Authorization is required.
Cost Sharing:
Mental Health Specialty Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Mental Health Specialty Services have a Coinsurance
Medicare-covered Individual Sessions, Medicare-covered Group Sessions
Individual Sessions for Mental Health Specialty Services benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Group Sessions for Mental Health Specialty Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Podiatry Services benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
Cost Sharing:
More Details:
Enhanced benefits (7f)
Routine Foot Care
Is this benefit unlimited?
No
Visits
4
Periodicity
Every year
Which Podiatry Services have a Coinsurance
Routine Foot Care
Minimum coinsurance
20
Maximum coinsurance
20
Which Podiatry Services have a Copayment
Medicare-covered Podiatry Services
Minimum copayment
0.00
Maximum copayment
0.00
Is there a maximum plan benefit coverage amount?
No
Other Health Care Professional benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Psychiatric Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Psychiatric Services have a Coinsurance
Medicare-covered Individual Sessions, Medicare-covered Group Sessions
Individual Sessions for Psychiatric Services benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Group Sessions for Psychiatric Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Physical Therapy and Speech-Language Pathology Services benefits are covered.
Cost Sharing:
More Details:
Is there a coinsurance?
Yes
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
No
Additional Telehealth Benefits benefits are covered – including services not usually covered by Medicare plans.
Cost Sharing:
More Details:
Medicare-covered benefits that may have Additional Telehealth Benefits available
4b: Urgently Needed Services, 7a: Primary Care Physician Services, 7d: Physician Specialist Services, 7e1: Individual Sessions for Mental Health Specialty Services, 7g: Other Health Care Professional, 7h1: Individual Sessions for Psychiatric Services, 9c1: Individual Sessions for Outpatient Substance Abuse
Opioid Treatment Program Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Home Health Services benefits are covered.
Cost Sharing:
More Details:
Is there a coinsurance?
No
Is there a copayment ?
Yes
Authorization required for this benefit?
Yes
Referral required for this benefit?
No
Not covered.
Not covered.
Partial Hospitalization benefits are covered. Prior Authorization is required.
Cost Sharing:
Emergency Services benefits are covered.
Emergency Services benefits are covered.
Cost Sharing:
More Details:
Is there a coinsurance?
No
Is there a copayment?
Yes
Is the copayment for Medicare-covered benefits waived if admitted to hospital?
Yes
Select either days or hours within which admission must occur for waiver
Hours
Enter number of days or hours
24
Does the cost sharing count towards any plan-level deductible?
No
Urgently Needed Services benefits are covered.
Cost Sharing:
More Details:
Is there a coinsurance?
No
Is there a copayment?
Yes
Is the copayment for Medicare-covered benefits waived if admitted to hospital?
No
Does the cost sharing count towards any plan-level deductible?
No
Worldwide Emergency Services benefits are covered – including services not usually covered by Medicare plans.
Cost Sharing:
More Details:
Which Worldwide Services have a Copayment
Worldwide Emergency Coverage, Worldwide Urgent Coverage, Worldwide Emergency Transportation
Is there a maximum plan benefit coverage?
No
Worldwide Emergency Coverage benefits are covered.
Cost Sharing:
Worldwide Urgent Coverage benefits are covered.
Cost Sharing:
Worldwide Emergency Transportation benefits are covered.
Cost Sharing:
Cardiac Rehabilitation Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Cardiac and Pulmonary Rehabilitation Services have a Coinsurance
Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Additional Cardiac Rehabilitation Services
Not covered.
Not covered.
Not covered.
Not covered.
Skilled Nursing Facility (SNF) benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Does the plan provide Skilled Nursing Facility Services as a supplemental benefit under Part C?
No
Do you allow less than 3 day inpatient hospital stay prior to SNF admission?
Yes
Days
Zero
Do you charge the Medicare-defined cost share for tier 1?
Yes
Periodicity
Original Medicare
Not covered.
Not covered.
Inpatient Hospital benefits are covered.
Inpatient Hospital-Acute benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
Cost Sharing:
More Details:
Enhanced benefits
Non-Medicare-covered Stay
Do you charge the Medicare-defined cost share for tier 1?
No
Copayment for Medicare-covered stay
1025.00
Periodicity
Per Admission or Per Stay
Do you charge cost sharing on the day of discharge?
No
Additional Days for Inpatient Hospital-Acute benefits are covered.
Days 91-999: | |
---|---|
Copayment | 0.00 |
More Details:
Is this benefit unlimited?
Yes
Number of day intervals for Additional Days
One
Not covered.
Not covered.
Inpatient Hospital Psychiatric benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Do you charge the Medicare-defined cost share for tier 1?
No
Copayment for Medicare-covered stay
1025.00
Periodicity
Per Admission or Per Stay
Do you charge cost sharing on the day of discharge?
No
Not covered.
Not covered.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
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