UnitedHealthcare The Villages MedicareComplete 1 Sumter County, Florida 2017 Medicare Advantage Plan H1045-025

HMO Plan
5-Star Rating:{plan}, a Medicare Advantage plan available in Sumter County, FL, an average Medicare rating of 4.5 out of 5 stars.
Plan ID:H1045-025
Plan Year:2017
Full Premium:$0.00/mo
Annual MOOP:$4,500
Part D Benefit:Yes
Rx Deductible:$0.00/year
Rx Gap Coverage:No
Online Pharmacy:No
Plan Phone #:866-231-7201
Summary of Benefits: UnitedHealthcare The Villages MedicareComplete 1 Medicare Advantage Plan H1045-025 Summary of Benefits for Sumter County, Florida

UnitedHealthcare The Villages MedicareComplete 1 Medicare Advantage Plan for Sumter County, Florida seniors on Medicare.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.

Monthly Premium

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.

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.

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Maximum Out-of-Pocket Limit

2017 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.

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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.

Doctor Visits

Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:

Primary Care Doctor:20% co-insurance
Physician Specialist:$30 co-payment
Chiropractor:$20 co-payment
Occupational Therapist:$30 co-payment
Physical Therapist:$30 co-payment
Speech Terapist:$30 co-payment
Psychotherapist:You pay nothing
Psychiatrist:You pay nothing
Podiatrist:$30 co-payment

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Preventive Care

Medicare covers a wide range of preventive care services, including cardiovascular screenings, alcohol misuse screening and counseling, depression screen, and diabetes screening, to name just a few. Here's how this plan covers the following at no cost:

  • 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
  • HIV screening
  • Medical nutrition therapy services
  • Obesity screening and counseling
  • Prostate cancer screenings (PSA)
  • Sexually transmitted infections screening and counseling
  • Tobacco use cessation counseling
  • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
  • 'Welcome to Medicare' preventive visit
  • Yearly 'Wellness' visit

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Urgent Care and Emergency Room

Urgent care and emergency room services are covered under Medicare Part B and have copayment or coinsurance fees. Some Medicare Advantage plans waive these fees if you are admitted as an inpatient within a specified number of days.

Urgent Care:$30 to $40 co-payment
Emergency Care:$75 co-payment
Co-insurance waived if admitted within 24 Hours
Worldwide Coverage:Yes
Ambulance:$250 co-payment

Hospital Stays

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:

  • Day 1 to 6 you pay $275 per day
  • See the Summary of Benefits for additional copayment periods.
The hospital benefit period is Per Stay. See Notes For Details..

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Prescription Drug Coverage

UnitedHealthcare The Villages MedicareComplete 1 includes Medicare Part D coverage for your prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy at each tier level.

TierDrug ClassCopay
1Preferred Generic$3
3Preferred Brand$45
4Non-Preferred Brand$95
5Specialty Tier33%

If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.

The annual Part D deductible is $0.00 (first dollar coverage).

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Medicare Plan Rating

Medicare gave the UnitedHealthcare The Villages MedicareComplete 1 plan an average rating of 4.5.0 out of 5 stars. This rating is Above Average, by Medicare's definition.

Medicare evaluates the quality of all Medicare Advantage plans. Plans are rated using a one to five-star scale, with five stars being the highest quality. If a plan is rated less than 2.5 stars, Medicare will not allow new members to enroll.

Compare Plans

Compare UnitedHealthcare The Villages MedicareComplete 1 with these top rated plans available in Sumter County:

UnitedHealthcare The Villages MedicareComplete 1 Availability

UnitedHealthcare The Villages MedicareComplete 1 is available in Webster, Bushnell, Coleman, Center Hill, Lake Panasoffkee, Sumterville, The Villages, Wildwood, Oxford, and all other areas of Sumter County.

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This page was last updated on 10/25/2016.