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UHC Choice Plus POS Gold 500 1 of 8 UHC Choice Plus POS Gold 500 Coverage Period: Based on group plan year Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Employee/Family Plan Type: POS. $20 copay per visit 20% co-ins, after ded Virtual visits (Telehealth) - $20 copay per visit by a Designated Virtual. UnitedHealthcare Tiered Benefit plans are built on traditional UnitedHealthcare health plans and include additional features that can help both members and employers save money. UnitedHealthcare Tiered Benefit plans feature lower copays and/or co-insurance when members seek care from a Tier 1 care provider for their primary care physician (PCP. UHC Choice Plus POS Platinum 0-1 1 of 7 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: - UHC Choice Plus POS Platinum 0-1 Coverage for: Employee/Family Plan Type: POS The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Get cost estimates before choosing care. You may pay up to 36% less 1. Checking cost estimates before you choose where to get care can be an effective way to save on health care costs. In fact, it’s been shown that people who look at costs first may pay up to 36% less for their care. So, it can be worthwhile.
UnitedHealthcare Medicare Advantage Choice (Regional PPO) R2604-001 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by UnitedHealthcare available to residents in South Carolina and Georgia. This plan includes additional Medicare prescription drug (Part-D) coverage. The UnitedHealthcare Medicare Advantage Choice (Regional PPO) has a monthly premium of $49.00 and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out of pocket. This can be a extremely nice safety net.
UnitedHealthcare Medicare Advantage Choice (Regional PPO) is a Regional PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
UnitedHealthcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for UnitedHealthcare Medicare Advantage Choice (Regional PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from UnitedHealthcare and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from UnitedHealthcare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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2021 UnitedHealthcare Medicare Advantage Plan Costs
| Name: | UnitedHealthcare Medicare Advantage Choice (Regional PPO) |
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| Provider: | UnitedHealthcare |
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| Year: | 2021 |
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| Type: | Regional PPO |
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| Monthly Premium C+D: | $49.00 |
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| Part C Premium: | $1.80 |
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| MOOP: | $6,700 |
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| Part D (Drug) Premium: | $47.20 |
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| Part D Supplemental Premium | $0 |
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| Total Part D Premium: | $47.20 |
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| Drug Deductible: | $295.0 |
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| Tiers with No Deductible: | 1 |
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| Gap Coverage: | No |
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| Benchmark: | not below the regional benchmark |
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| Type of Medicare Health: | Enhanced Alternative |
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| Drug Benefit Type: | Enhanced |
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| Similar Plan: | R2604-005 |
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UnitedHealthcare Medicare Advantage Choice (Regional PPO) Part-C Premium
UnitedHealthcare plan charges a $1.80 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
R2604-001 Part-D Deductible and Premium
UnitedHealthcare Medicare Advantage Choice (Regional PPO) has a monthly drug premium of $47.20 and a $295.0 drug deductible. This UnitedHealthcare plan offers a $47.20 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by UnitedHealthcare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $47.20. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
UnitedHealthcare Gap Coverage
In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This UnitedHealthcare plan does not offer additional coverage through the gap.
Premium Assistance
The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The UnitedHealthcare Medicare Advantage Choice (Regional PPO) medicare insurance offers a $18.20 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $25.40 for 75% low income subsidy $32.70 for 50% and $39.90 for 25%.
| Full LIS Premium: | $18.20 |
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| 75% LIS Premium: | $25.40 |
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| 50% LIS Premium: | $32.70 |
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| 25% LIS Premium: | $39.90 |
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R2604-001 Formulary or Drug Coverage
UnitedHealthcare Medicare Advantage Choice (Regional PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2021 UnitedHealthcare Medicare Advantage Choice (Regional PPO) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | Not covered |
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| Endodontics | Not covered |
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| Extractions | Not covered |
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| Non-routine services | Not covered |
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| Periodontics | Not covered |
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| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
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| Restorative services | Not covered |
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Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $0-175 copay |
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| Diagnostic radiology services (e.g., MRI) | $0-175 copay (Out-of-Network) |
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| Diagnostic tests and procedures | $30 copay (Out-of-Network) |
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| Diagnostic tests and procedures | $30 copay |
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| Lab services | $0 copay |
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| Lab services | $0 copay (Out-of-Network) |
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| Outpatient x-rays | $15 copay |
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| Outpatient x-rays | $15 copay (Out-of-Network) |
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Doctor Visits
| Primary | $25-45 copay per visit (Out-of-Network) |
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| Primary | $5 copay per visit |
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| Specialist | $45 copay per visit (Out-of-Network) |
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| Specialist | $45 copay per visit |
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Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
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| Urgent care | $30-40 copay per visit (always covered) |
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Foot Care (podiatry services)
| Foot exams and treatment | $45 copay |
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| Foot exams and treatment | $45 copay (Out-of-Network) |
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| Routine foot care | $45 copay |
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| Routine foot care | $45 copay (Out-of-Network) |
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Ground Ambulance
| $250 copay (Out-of-Network) |
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| $250 copay |
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Hearing
| Fitting/evaluation | Not covered |
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| Hearing aids | $375-2,075 copay |
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| Hearing aids | $375 copay (Out-of-Network) |
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| Hearing exam | $0 copay |
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| Hearing exam | $45 copay (Out-of-Network) |
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Inpatient Hospital Coverage
$395 per day for days 1 through 4
$0 per day for days 5 and beyond (Out-of-Network) |
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$395 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond |
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Medical Equipment/Supplies
| Diabetes supplies | 20% coinsurance per item (Out-of-Network) |
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| Diabetes supplies | $0 copay per item |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | $55 copay or 50% coinsurance per item (Out-of-Network) |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Out-of-Network) |
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Medicare Part B Drugs
| Chemotherapy | 20% coinsurance (Out-of-Network) |
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| Chemotherapy | 20% coinsurance |
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| Other Part B drugs | 20% coinsurance (Out-of-Network) |
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| Other Part B drugs | 20% coinsurance |
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Mental Health Services
| Inpatient hospital - psychiatric | $395 per day for days 1 through 4
$0 per day for days 5 through 90 (Out-of-Network) |
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| Inpatient hospital - psychiatric | $395 per day for days 1 through 4
$0 per day for days 5 through 90 |
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| Outpatient group therapy visit | $15-25 copay (Out-of-Network) |
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| Outpatient group therapy visit | $15 copay |
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| Outpatient group therapy visit with a psychiatrist | $15 copay |
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| Outpatient group therapy visit with a psychiatrist | $15-25 copay (Out-of-Network) |
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| Outpatient individual therapy visit | $15-25 copay (Out-of-Network) |
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| Outpatient individual therapy visit | $25 copay |
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| Outpatient individual therapy visit with a psychiatrist | $25 copay |
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| Outpatient individual therapy visit with a psychiatrist | $15-25 copay (Out-of-Network) |
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MOOP
$6,700 In and Out-of-network
$6,700 In-network |
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.jpg "Choice")
Option
Optional supplemental benefits
Outpatient Hospital Coverage
Unitedhealthcare Choice Plus Formulary
| $0-395 copay per visit |
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| $0-395 copay per visit (Out-of-Network) |
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Package #1
| Deductible |
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| Monthly Premium | $45.00 |
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Preventive Care
| $0 copay (Out-of-Network) |
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| $0 copay |
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Preventive Dental
| Cleaning | Not covered |
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| Dental x-ray(s) | Not covered |
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| Fluoride treatment | Not covered |
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| Oral exam | Not covered |
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Rehabilitation Services
| Occupational therapy visit | $40 copay |
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| Occupational therapy visit | $40 copay (Out-of-Network) |
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| Physical therapy and speech and language therapy visit | $40 copay (Out-of-Network) |
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| Physical therapy and speech and language therapy visit | $40 copay |
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Skilled Nursing Facility
$225 per day for days 1 through 30
$0 per day for days 31 through 100 (Out-of-Network) |
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$0 per day for days 1 through 20
$184 per day for days 21 through 57
$0 per day for days 58 through 100 |
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Transportation
Vision
United Healthcare Choice Plus Copay Plan
| Contact lenses | Not covered |
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| Eyeglass frames | Not covered |
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| Eyeglass lenses | Not covered |
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| Eyeglasses (frames and lenses) | Not covered |
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| Other | Not covered |
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| Routine eye exam | $0 copay (Out-of-Network) |
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| Routine eye exam | $0 copay |
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| Upgrades | Not covered |
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Wellness Programs (e.g. fitness nursing hotline)
Reviews for UnitedHealthcare Medicare Advantage Choice (Regional PPO) R2604
| 2019 Overall Rating |
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| Part C Summary Rating |
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| Part D Summary Rating |
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| Staying Healthy: Screenings, Tests, Vaccines |
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| Managing Chronic (Long Term) Conditions |
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| Member Experience with Health Plan |
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| Complaints and Changes in Plans Performance |
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| Health Plan Customer Service |
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| Drug Plan Customer Service |
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| Complaints and Changes in the Drug Plan |
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| Member Experience with the Drug Plan |
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| Drug Safety and Accuracy of Drug Pricing |
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What Is Covered Under Unitedhealthcare Choice Plus
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
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| Breast Cancer Screening |
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| Colorectal Cancer Screening |
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| Annual Flu Vaccine |
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| Improving Physical |
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| Improving Mental Health |
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| Monitoring Physical Activity |
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| Adult BMI Assessment |
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Managing Chronic And Long Term Care for Older Adults
| Total Rating |
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| SNP Care Management |
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| Medication Review |
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| Functional Status Assessment |
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| Pain Screening |
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| Osteoporosis Management |
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| Diabetes Care - Eye Exam |
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| Diabetes Care - Kidney Disease |
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| Diabetes Care - Blood Sugar |
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| Rheumatoid Arthritis |
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| Reducing Risk of Falling |
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| Improving Bladder Control |
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| Medication Reconciliation |
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| Statin Therapy |
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Member Experience with Health Plan
United Healthcare Choice Plus Copay
| Total Experience Rating |
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| Getting Needed Care |
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| Customer Service |
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| Health Care Quality |
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| Rating of Health Plan |
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| Care Coordination |
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Member Complaints and Changes in UnitedHealthcare Medicare Advantage Choice (Regional PPO) Plans Performance
| Total Rating |
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| Complaints about Health Plan |
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| Members Leaving the Plan |
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| Health Plan Quality Improvement |
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| Timely Decisions About Appeals |
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Health Plan Customer Service Rating for UnitedHealthcare Medicare Advantage Choice (Regional PPO)
| Total Customer Service Rating |
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| Reviewing Appeals Decisions |
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| Call Center, TTY, Foreign Language |
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UnitedHealthcare Medicare Advantage Choice (Regional PPO) Drug Plan Customer Service Ratings
| Total Rating |
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| Call Center, TTY, Foreign Language |
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| Appeals Auto |
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| Appeals Upheld |
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Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
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| Complaints about the Drug Plan |
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| Members Choosing to Leave the Plan |
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| Drug Plan Quality Improvement |
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Member Experience with the Drug Plan
| Total Rating |
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| Rating of Drug Plan |
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| Getting Needed Prescription Drugs |
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Drug Safety and Accuracy of Drug Pricing
| Total Rating |
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| MPF Price Accuracy |
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| Drug Adherence for Diabetes Medications |
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| Drug Adherence for Hypertension (RAS antagonists) |
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| Drug Adherence for Cholesterol (Statins) |
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| MTM Program Completion Rate for CMR |
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| Statin with Diabetes |
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What Is Unitedhealthcare Choice Plus
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for UnitedHealthcare Medicare Advantage Choice (Regional PPO)
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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.