In-Network: $550 copay per day for days 1-5, $0 copay per day for days 6-90.
Skilled nursingIn Network
In-Network: $0 copay per day for days 1-20, $221 copay per day for days 21-100.
Emergency careIn Network
In-Network: $130 copay per visit
Urgently needed careIn Network
In-Network: $50 copay for Medicare-covered urgently-needed-care visits.
AmbulanceIn Network
In-Network: $350 copay per trip
DentalIn Network
In-Network: $0 copay for covered preventive services such as oral exams, routine cleanings, X-rays and fluoride
You will have access to one of Medicare Advantage's largest dental networks, or you can choose any dentist.
VisionIn Network
This plan includes: Eye Exams, Eyewear.
HearingIn Network
In-Network: $0 copay for Medicare-covered Hearing Services
FitnessIn Network
In-Network: $0 copay for Renew Active®, which includes a free membership at core and premium gyms
Notes
Drug deductible details: $0 Deductible on Tier(s) 1, 2; $685 Deductible on Tier(s) 3, 4, 5
Plan Overview
CarrierUnitedHealthcare
Plan typeMAPD
PlanLPPO
Marketing nameUnitedHealthcare
Drug coverageIncluded
Enrollment hours8 a.m.-8 p.m. local time, 7 days a week
