|Part D Benefit:||Yes|
|Rx Gap Coverage:||No|
|Plan Phone #:||866-231-7201|
|Summary of Benefits:|
UnitedHealthcare The Villages MedicareComplete 1 is a Health Maintenance Organization (HMO) Medicare Advantage plan, by Preferred Care Partners, available in Sumter County, Florida. It offers all of the basic benefits of Original Medicare and may include additional coverage.
With an HMO plan, like this one from Preferred Care Partners, your out-of-pocket costs are much lower than Original Medicare. That's the big advantage.
IMPORTANT: You must use providers in the Preferred Care Partners network to avoid incurring additional costs. You are responsible for all costs incurred out of network. Referrals are generally required to see specialists.
This plan has a zero dollar premium!
If you enroll in the UnitedHealthcare The Villages MedicareComplete 1 plan you will continue to pay your Medicare Part B premium. However, there's no additional monthly premium to be in this plan. Be aware that some people pay a higher Part B premium due to their annual income level (over $85,000 per year for singles or $170,000 for married couples) or due to a late enrollment penalty.
IMPORTANT NOTICE: Double-digit price hikes for Medicare Part B premiums are coming in 2016. The base tier premium is expected to jump from $104.90 to $120.70.
In addition to the premiums you also pay your share when you use healthcare services. Each time you see your doctor, or if you are admitted as an inpatient (hospitalized), you'll pay copayments. Your prescription drugs also have a cost sharing component.
Maximum Out-of-Pocket Limit
2016 Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit that protects you from financial disaster. The MOOP limit is $6,700, but plans can go as low as $3,400.
The most you will pay out-of-pocket if you enroll in this plan is $4,500. This amount does not include your monthly premium or the copayments. This is only the amount that you pay out of pocket.
Don't forget to look at the co-payments and co-insurance with Original Medicare (no out-of-pocket limits). If you stay on Original Medicare you'll need a Medicare Supplement to pay the gaps or pay it yourself.
Coverage, Copayments & Coinsurance
The UnitedHealthcare The Villages MedicareComplete 1 plan offers the same basic benefits as Original Medicare. The big difference is copayments and coinsurances. Below you will find (where available) what you will pay for common health care services.
Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:
- Acupuncture and Other Alternative Therapies
- Not covered
- Ambulance Services
- $250 copay
- Chiropractic Care
- Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position): $20 copay
- Dental Services
- Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth): $30 copay
- Preventive dental services:
- Cleaning (for up to 1 every six months): No cost to you.
- Dental x-ray(s) (for up to 1): No cost to you.
- Oral exam (for up to 1 every six months): No cost to you.
- Diabetes Supplies and Services
- Diabetes monitoring supplies: No cost to you
- Diabetes self-management training: No cost to you
- Therapeutic shoes or inserts: 20% of the cost
- Diagnostic Tests, Lab and Radiology Services, and X-Rays
- Diagnostic radiology services (such as MRIs CT scans): 20% of the cost
- Diagnostic tests and procedures: 20% of the cost
- Lab services: $13 copay
- Outpatient x-rays: $16 copay
- Therapeutic radiology services (such as radiation treatment for cancer): 20% of the cost
- Doctor's Office Visits
- Primary care physician visit: No cost to you
- Specialist visit: $30 copay
- Durable Medical Equipment (wheelchairs, oxygen, etc.)
- 20% of the cost
- Emergency Care
- $65 copay
- If you are admitted to the hospital within 24 hours you do not have to pay your share of the cost for emergency care. See the Inpatient Hospital Care section for other costs.
- Foot Care (podiatry services)
- Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions: $30 copay
- Routine foot care (for up to 6 visit(s) every year): $30 copay
- Hearing Services
- Exam to diagnose and treat hearing and balance issues: $30 copay
- Routine hearing exam (for up to 1 every year): No cost to you
- Hearing aid: $100-150 co-pay for each hearing aid depending on the type
- Home Health Care
- No cost to you
- Mental Health Care
- Inpatient visit:
- UnitedHealthcare The Villages MedicareComplete 1 covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital. The inpatient hospital care limit does not apply to inpatient mental services provided in a general hospital.
- UnitedHealthcare The Villages MedicareComplete 1 covers 90 days for an inpatient hospital stay.
- UnitedHealthcare The Villages MedicareComplete 1 also covers 60 lifetime reserve days. These are extra days UnitedHealthcare The Villages MedicareComplete 1 covers. If you are an inpatient for more than 90 days you can use these extra days. But once you have used up these extra 60 days your inpatient hospital coverage will be limited to 90 days.
- $275 co-pay per day for days 1 through 5.
- No cost to you per day for days 6 through 90.
- Outpatient group therapy visit: No cost to you
- Outpatient individual therapy visit: No cost to you
- Outpatient Rehabilitation Services
- Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks): $30 copay
- Occupational therapy visit: $30 copay
- Physical therapy and speech and language therapy visit: $30 copay
- Outpatient Substance Abuse
- Group therapy visit: No cost to you
- Individual therapy visit: No cost to you
- Outpatient Surgery
- Ambulatory surgical center: $270 copay
- Outpatient hospital: $270 copay
- Over-the-Counter Items
- Not Covered
- Prosthetic Devices (braces, artificial limbs, etc.)
- Prosthetic devices: 20% of the cost
- Related medical supplies: 20% of the cost
- Renal Dialysis
- 20% of the cost
- Not covered
- Urgently Needed Care
- $30-40 co-pay depending on the service
- Vision Services
- Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening): $0-30 co-pay depending on the service
- Routine eye exam (for up to 1 every year): $30 copay
- Contact lenses: $30 copay
- UnitedHealthcare The Villages MedicareComplete 1 pays up to $105 every two years for contact lenses.
- Eyeglasses frames (for up to 1 every two years): $30 copay
- UnitedHealthcare The Villages MedicareComplete 1 pays up to $70 every two years for eyeglass frames.
- Eyeglasses lenses (for up to 1 every two years): No cost to you
- Eyeglasses or contact lenses after cataract surgery: No cost to you
If you are admitted to a hospital or clinic for treatment and stay overnight, you are an inpatient. Most plans have tiered costs for inpatient treatment. Here's how this plan covers you:
- UnitedHealthcare The Villages MedicareComplete 1 covers an unlimited number of days for an inpatient hospital stay.
- $275 co-payment per day for days 1 through 6.
- You pay nothing per day for days 7 through 90.
- You pay nothing per day for days 91 and beyond.
- UnitedHealthcare The Villages MedicareComplete 1 covers up to 100 days in a Skilled Nursing Facility (SNF).
- You pay nothing per day for days 1 through 20.
- $155 co-payment per day for days 21 through 50.
- You pay nothing per day for days 51 through 100.
Medicare covers some preventive care services, including cardiovascular screenings, alcohol misuse screening and counseling, depression screen, and diabetes screening. This plan covers preventive services as follows:
- Preventive Care
- You pay nothing
- UnitedHealthcare The Villages MedicareComplete 1 covers many preventive services including:
- Abdominal aortic aneurysm screening.
- Alcohol misuse counseling.
- Bone mass measurement.
- Breast cancer screening (mammogram).
- Cardiovascular disease (behavioral therapy).
- Cardiovascular screenings.
- Cervical and vaginal cancer screening.
- Colorectal cancer screenings.
- Depression screening.
- Diabetes screenings.
- Fecal occult blood test.
- Flexible sigmoidoscopy.
- HIV screening.
- Medical nutrition therapy services.
- Obesity screening and counseling.
- Prostate cancer screenings (PSA).
- Sexually transmitted infections screening and counseling.
- Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease) .
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots.
- Welcome to Medicare preventive visit (one-time checkup).
- Yearly Wellness visit.
- All other preventive healthcare services approved by Medicare during the contract year will be covered.
Prescription Drug Coverage
This plan includes Medicare Part D coverage for your prescription medications. The formulary (00015006) has a total of 3,649 prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy for medications at each tier level.
|Formulary Drug Details:||Tier 1||Tier 2||Tier 3||Tier 4||Tier 5|
|— Drugs per Tier:||310||569||960||1130||680|
|— Cost-Sharing in ICP:||$3.00||$7.00||$45.00||$95.00||33%|
If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.
The Part D deductible on this plan is $0.00 (first dollar coverage).
Medicare Plan Rating
Medicare gave the UnitedHealthcare The Villages MedicareComplete 1 plan an average rating of 4.0 out of 5 stars. This rating is Above Average, by Medicare's definition.
Medicare rates the quality of all Medicare Advantage plans. Ratings help shopper considering enrollment. Five stars represents the best quality. Plans rated less than 2.5 stars cannot be sold.
Compare UnitedHealthcare The Villages MedicareComplete 1 with these top rated plans available in Sumter County:
- Freedom Medicare Plan Rx
- Freedom Platinum Plan Rx
- Freedom Savings Plan
- Humana Gold Choice H8145-061
UnitedHealthcare The Villages MedicareComplete 1 Availability
UnitedHealthcare The Villages MedicareComplete 1 is available in Sumterville, Center Hill, Oxford, Webster, Coleman, Bushnell, Wildwood, The Villages, Lake Panasoffkee, and all other areas of Sumter County.
This page was last updated on 10/12/2015.