Plan Basics
Contract Year |
2021 |
Medicare Type |
Medicare Advantage Plan (Part C) |
CMS Plan ID |
H8748-008-000 |
Plan Organization |
UnitedHealthcare |
Plan Type |
Local HMO |
Plan Name |
AARP Medicare Advantage Plus Plan 1 (HMO-POS) |
Plan Organization Type |
Local CCP |
Drugs Covered |
Yes |
Doctors Choice |
Plan Doctors Only (some exceptions) |
Benefit Type |
Enhanced Alternative |
Special Needs Plan |
No |
Overall Star Rating |
3.5 |
Plan Cost Sharing
Premium |
$0.00 |
Total Premium (Includes Part B) |
$135.50 |
Monthly Part C Premium |
$0.00 |
Monthly Part D Basic Premium |
$0.00 |
Monthly Part D Supplemental Premium |
$0.00 |
Monthly Part D Total Premium |
$0.00 |
Monthly Part D Premium Full Assistance |
$0.00 |
Monthly Part D Premium 75% Assistance |
$0.00 |
Monthly Part D Premium 50% Assistance |
$0.00 |
Monthly Part D Premium 25% Assistance |
$0.00 |
Part D Drug Deductible |
$275.00 |
Annual Drug Deductible |
$275.00 |
Tiers Excluded From Deductible |
1 |
Part D Initial Coverage Limit |
$4130.00 |
Part D Catastrophic Coverage Threshold |
$6550.00 |
Maximum Out-of-Pocket Limit for Parts A & B (MOOP) |
$6700.00 |
Gap Coverage |
No |
Medicare Advantage Plan Health Benefits
Additional Benefits And/or Reduced Cost-sharing For Enrollees With Certain Health Conditions?
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
In-Network |
- |
- |
No |
Comprehensive Dental
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Diagnostic services |
No |
- |
- |
- |
Not covered |
Endodontics |
No |
- |
- |
- |
Not covered |
Extractions |
No |
- |
- |
- |
Not covered |
Non-routine services |
No |
- |
- |
- |
Not covered |
Periodontics |
No |
- |
- |
- |
Not covered |
Prosthodontics, other oral/maxillofacial surgery, other services |
No |
- |
- |
- |
Not covered |
Restorative services |
No |
- |
- |
- |
Not covered |
Diagnostic Procedures/lab Services/imaging
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Diagnostic radiology services (e.g., MRI) |
- |
In-Network |
Yes |
No |
$0-110 copay |
Diagnostic tests and procedures |
- |
In-Network |
Yes |
No |
$20 copay |
Lab services |
- |
In-Network |
Yes |
No |
$0 copay |
Outpatient x-rays |
- |
In-Network |
Yes |
No |
$15 copay |
Doctor Visits
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Primary |
- |
In-Network |
- |
- |
$0 copay |
Specialist |
- |
In-Network |
Yes |
No |
$45 copay per visit |
Emergency Care/Urgent Care
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Emergency |
- |
- |
- |
- |
$90 copay per visit (always covered) |
Urgent care |
- |
- |
- |
- |
$30-40 copay per visit (always covered) |
Foot Care (podiatry Services)
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Foot exams and treatment |
- |
In-Network |
Yes |
No |
$45 copay |
Routine foot care |
Yes |
In-Network |
Yes |
No |
$45 copay |
Ground Ambulance
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
Out-of-Network |
- |
- |
$250 copay |
Health Plan Deductible
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
- |
- |
- |
$0 |
Hearing
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Fitting/evaluation |
No |
- |
- |
- |
Not covered |
Hearing aids |
Yes |
In-Network |
Yes |
No |
$375-2,075 copay |
Hearing exam |
- |
In-Network |
Yes |
No |
$0 copay |
Inpatient Hospital Coverage
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
Out-of-Network |
Yes |
No |
Not Applicable |
Maximum Out-of-pocket Enrollee Responsibility (does Not Include Prescription Drugs)
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
- |
- |
- |
$6,700 In-network$10,000 Out-of-network |
Medical Equipment/supplies
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Diabetes supplies |
- |
In-Network |
Yes |
- |
$0 copay per item |
Durable medical equipment (e.g., wheelchairs, oxygen) |
- |
In-Network |
Yes |
- |
20% coinsurance per item |
Prosthetics (e.g., braces, artificial limbs) |
- |
In-Network |
Yes |
- |
20% coinsurance per item |
Medicare Part B Drugs
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Chemotherapy |
- |
In-Network |
Yes |
- |
20% coinsurance |
Other Part B drugs |
- |
In-Network |
Yes |
- |
20% coinsurance |
Mental Health Services
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Inpatient hospital - psychiatric |
- |
Out-of-Network |
Yes |
No |
40% per stay |
Outpatient group therapy visit |
- |
Out-of-Network |
Yes |
No |
40% coinsurance |
Outpatient group therapy visit with a psychiatrist |
- |
Out-of-Network |
Yes |
No |
40% coinsurance |
Outpatient individual therapy visit |
- |
Out-of-Network |
Yes |
No |
40% coinsurance |
Outpatient individual therapy visit with a psychiatrist |
- |
Out-of-Network |
Yes |
No |
40% coinsurance |
Optional Supplemental Benefits
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
- |
- |
- |
Yes |
Other Health Plan Deductibles?
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
In-Network |
- |
- |
No |
Outpatient Hospital Coverage
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
In-Network |
Yes |
No |
$0-370 copay per visit |
Preventive Care
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
In-Network |
No |
No |
$0 copay |
Preventive Dental
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Cleaning |
No |
- |
- |
- |
Not covered |
Dental x-ray(s) |
No |
- |
- |
- |
Not covered |
Fluoride treatment |
No |
- |
- |
- |
Not covered |
Oral exam |
No |
- |
- |
- |
Not covered |
Rehabilitation Services
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Occupational therapy visit |
- |
In-Network |
Yes |
No |
$40 copay |
Physical therapy and speech and language therapy visit |
- |
In-Network |
Yes |
No |
$40 copay |
Skilled Nursing Facility
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
Out-of-Network |
Yes |
No |
Not Applicable |
Transportation
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
- |
- |
- |
Not covered |
Vision
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
Contact lenses |
Yes |
In-Network |
No |
No |
$0 copay |
Eyeglass frames |
No |
- |
- |
- |
Not covered |
Eyeglass lenses |
No |
- |
- |
- |
Not covered |
Eyeglasses (frames and lenses) |
Yes |
In-Network |
No |
No |
$0 copay |
Other |
No |
- |
- |
- |
Not covered |
Routine eye exam |
Yes |
In-Network |
Yes |
No |
$0 copay |
Upgrades |
- |
- |
- |
- |
Not covered |
Wellness Programs (e.g., Fitness, Nursing Hotline)
Service |
Cap |
Network |
Auth. Req. |
Ref. Req. |
Cost Share |
|
- |
- |
No |
No |
Covered |
Medicare Plan Packages
Package #1
Category |
Cost Sharing Type |
Cost Share |
Comprehensive dental |
Monthly Premium |
$45.00 |
Preventive dental |
Monthly Premium |
$45.00 |
Official Medicare Contact
Medicare Phone |
1-800-MEDICARE (1-800-633-4227) |
Medicare TTY User |
1-877-486-2048 |
Plan Available in these Counties
Baldwin County, Georgia,
Banks County, Georgia,
Barrow County, Georgia,
Ben Hill County, Georgia,
Bryan County, Georgia,
Bulloch County, Georgia,
Clarke County, Georgia,
Coweta County, Georgia,
Crawford County, Georgia,
Crisp County, Georgia,
Dawson County, Georgia,
Dodge County, Georgia,
Dooly County, Georgia,
Douglas County, Georgia,
Effingham County, Georgia,
Emanuel County, Georgia,
Evans County, Georgia,
Fayette County, Georgia,
Gwinnett County, Georgia,
Habersham County, Georgia,
Hall County, Georgia,
Houston County, Georgia,
Irwin County, Georgia,
Jackson County, Georgia,
Johnson County, Georgia,
Laurens County, Georgia,
Lumpkin County, Georgia,
Macon County, Georgia,
Montgomery County, Georgia,
Newton County, Georgia,
Oconee County, Georgia,
Paulding County, Georgia,
Peach County, Georgia,
Pulaski County, Georgia,
Rockdale County, Georgia,
Spalding County, Georgia,
Stephens County, Georgia,
Taylor County, Georgia,
Telfair County, Georgia,
Tift County, Georgia,
Toombs County, Georgia,
Towns County, Georgia,
Treutlen County, Georgia,
Turner County, Georgia,
Twiggs County, Georgia,
Union County, Georgia,
Upson County, Georgia,
Walton County, Georgia,
White County, Georgia,
Wilcox County, Georgia,
Wilkinson County, Georgia
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