UnitedHealthcare Medicare Advantage Plan 1 (HMO-POS) New Haven County, Connecticut Medicare Advantage Plan
UnitedHealthcare Medicare Advantage Plan 1 is a 2023 Medicare Advantage HMO-POS plan for people on Medicare who live in New Haven County, Connecticut. This UnitedHealthcare private health plan is required to provide all of the same benefits as Original Medicare, and may offer additional benefits, but the out-of-pocket costs are different.
Key Takeaways
- UnitedHealthcare Medicare Advantage Plan 1 is a HMO-POS Medicare Advantage plan.
- It provides all the same benefits as Original Medicare.
- It features a flexible provider network that allows members use healthcare providers outside of the plan network for certain situations or certain types of treatment.
- When out-of-network services are used, members pay an additional point-of-service (POS) fee.
- It offers additional benefits that Medicare Part A and Medicare Part B do not include.
- The monthly premium is $84.00 (plus your monthly Medicare Part B premium).
- This plan does not offer a Medicare Part B premium reduction (no giveback benefit).
- The health plan does not have an annual deductible.
- Your maximum out-of-pocket expenses with this plan are $4,700 (in-network).
- UnitedHealthcare Medicare Advantage Plan 1 includes a Medicare Part D plan for prescription medications. There is no annual deductible. Cost sharing begins with your first prescription.
- It offers the following supplemental benefits: Dental, Vision, Hearing (limitations apply, see below).
| Plan Basics | |
|---|---|
| Plan ID: | H0755-030-0 |
| Plan Type: | Local HMO |
| Plan Year: | 2023 |
| Premium: | $84.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $4,700/yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Rx Gap Coverage: | Yes |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | New Haven County, CT |
| Insured By: | UnitedHealthcare |
WARNING: Before enrolling in this or any other Medicare Advantage plan, it is very important to understand what your costs will be for both inpatient and outpatient careOutpatient Care is medical care that does not require an overnight stay at the hospital. Medicare Part B provides coverage for Outpatient Care.. Feel free to download our Summary of Benefits document to help you compare this plan.
Health Plan Costs & Benefits
PremiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., and copays vary widely from plan to plan. It is very important to compare costs and apply them to your personal financial and healthcare needs.
Monthly Premium
UnitedHealthcare Medicare Advantage Plan 1's total monthly premium in New Haven County is $84.00. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above....
Some Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). include a monthly Part B premium reduction, also known as the Medicare give back. This plan's Part B premium reduction is $0.00. The monthly premium does not include the plan's supplemental premium for add-on benefits (if available).
Annual Deductible
UnitedHealthcare Medicare Advantage Plan 1's annual health plan deductible is $0.00. This does not include the deductible for the prescription drug plan (if any), which is detailed below.
Maximum Out-of-Pocket Limit
The Maximum Out-of-Pocket (MOOP) with this UnitedHealthcare plan is $4,700. Unlike Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage., Medicare Advantage plans must set an annual Maximum Out-of-Pocket (MOOP) limit on inpatient and outpatient healthcare services. Once you reach this amount of spending on your copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., all of your Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B services will be covered at no additional charge for the remainder of the year. MOOP does not include monthly premiums, prescriptions, or other extra benefits.
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. you will incur if you join this UnitedHealthcare plan:
| Healthcare Service | Member Cost |
|---|---|
| Health plan deductible | $0 |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $4,700 In-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... |
| Doctor Visits | |
| Specialist (In-Network) | $30 copay per visit (authorization required) |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Inpatient hospital - psychiatric (Out-of-Net) | Not Applicable (authorization required) |
| Inpatient hospital - psychiatric (In-Network) | $345 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) |
| Outpatient group therapy visit (In-Network) | $15 copay (authorization required) |
| Outpatient individual therapy visit (In-Network) | $25 copay (authorization required) |
| Outpatient group therapy visit with a psychiatrist (In-Network) | $15 copay (authorization required) |
| Rehabilitation Services | |
| Physical therapy and speech and language therapy visit (In-Network) | $20 copay (authorization required) |
| Medical Equipment / Supplies | |
| Prosthetics (e.g., braces, artificial limbs) (In-Network) | 20% coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. per item (authorization required) |
| Durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds. (e.g., wheelchairs, oxygen) (In-Network) | 20% coinsurance per item (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Outpatient x-rays (In-Network) | $15 copay (authorization required) |
| Lab services (In-Network) | $0 copay (authorization required) |
| Diagnostic radiology services (e.g., MRI) (In-Network) | $0-140 copay (authorization required) |
| Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. Drugs | |
| Other Part B drugs (In-Network) | 0-20% coinsurance (authorization required) |
| Foot Care (podiatry Services) | |
| Foot exams and treatment (In-Network) | $30 copay (authorization required) |
| Hearing | |
| Hearing exam (In-Network) | $0 copay (authorization required) |
| Fitting/evaluation | Not covered |
| Preventive Dental | |
| Oral exam (Out-of-Net) | $0 copay (limits may apply) |
| Cleaning (In-Network) | $0 copay (limits may apply) |
| Oral exam (In-Network) | $0 copay (limits may apply) |
| Fluoride treatment (In-Network) | $0 copay (limits may apply) |
| Dental x-ray(s) (Out-of-Net) | $0 copay (limits may apply) |
| Cleaning (Out-of-Net) | $0 copay (limits may apply) |
| Dental x-ray(s) (In-Network) | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
| Extractions | Not covered |
| Restorative services | Not covered |
| Periodontics | Not covered |
| Non-routine services | Not covered |
| Diagnostic services | Not covered |
| Vision | |
| Eyeglass frames | Not covered |
| Upgrades | Not covered |
| Other | Not covered |
| Contact lenses (In-Network) | $0 copay (limits may apply) |
| Eyeglass lenses | Not covered |
| Routine eye exam (In-Network) | $0 copay (authorization required, limits may apply) |
| Emergency Care / Urgent Care | |
| Urgent care | $40 copay per visit (always covered) |
| Ground ambulance | $250 copay |
| Inpatient hospital coverage | $345 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 and beyond |
| Outpatient hospital coverage | $0-300 copay per visit |
| Skilled Nursing Facility | Not Applicable |
| Optional supplemental benefits | Yes |
Feel free to download our UnitedHealthcare Medicare Advantage Plan 1 Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
UnitedHealthcare Medicare Advantage Plan 1 includes an enhanced benefit Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Enhanced plans generally have higher monthly premiums than basic benefit plans but offer more benefits. For example, many enhanced PDPs do not have an annual deductible, may offer additional coverage during the coverage gap (aka, "donut hole"), and may have a broader list of supported drugs, known as a formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.. Some enhanced PDPs even cover excluded drugs. It's important to remember that benefits vary from plan to plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidySocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $27.90 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $27.90 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $7.00 |
| Part D Premium with 50% LIS Assistance: | $13.90 |
| Part D Premium with 25% LIS Assistance: | $20.90 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before UnitedHealthcare begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, UnitedHealthcare Medicare Advantage Plan 1 has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | N/A | $0.00 copay |
| 2 (Generic) | N/A | $8.00 copay |
| 3 (Preferred Brand) | N/A | $47.00 copay |
| 4 (Non-Preferred Drug) | N/A | $100.00 copay |
| 5 (Specialty Tier) | N/A | 33% |
CMS Rating Marks and Our Review
It's not a 5-star HMO-POS plan, but its quality of care exceeds most Medicare Advantage HMO-POS plans in the areas served (see list below). Staying healthy is the best way to save money on health care, and UnitedHealthcare Medicare Advantage Plan 1 does a good job keeping its members in top health through preventive care, including screenings, tests, and vaccines. This plan is good at managing its member's chronic (long-term) health conditions. The member experience with this UnitedHealthcare plan is average. Complaints and changes in plan performance are one way we can measure quality, and this plan scores good at both. The plan shines at customer service with an overall excellent mark on this important metric.
Beneficiaries searching for top value will find dental, vision, and hearing benefits available with this Medicare Advantage plan (limitations apply). Prospective members should carefully evaluate plan costs and benefits to understand if the plan's $84.00 dollar per month premium makes sense. One of the most important considerations is a plan's maximum out-of-pocket (MOOP) limit. UnitedHealthcare Medicare Advantage Plan 1's annual MOOP is set at $4,700, which does not include prescriptions. Even though members have copays with this health plan, they don't have to worry about a deductible.
The following table shows the quality ratings for this UnitedHealthcare plan. Each year CMS rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories. We do not recommend joining a plan with an overall rating of less than 3.0:
| CMS Measure | Star Rating |
|---|---|
| 2023 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Additional HMO-POS Medicare Advantage Plan Options
Here are some additional Medicare Advantage plans in New Haven County (HMO-POSs) that might be worth reviewing:
- UnitedHealthcare Medicare Advantage Plan 3
- Aetna Medicare Value Plan
- ConnectiCare Flex Plan 2
- UnitedHealthcare Medicare Advantage Patriot
- ConnectiCare Flex Plan 3
Contact UnitedHealthcare
| Plan Website: | http://www.UHCMedicareSolutions.com |
|---|---|
| Formulay Information: | http://www.UHCMedicareSolutions.com |
| Pharmacy Information: | UnitedHealthcare Pharmacy Page |
| Prospective Members: | (800)555-5757 |
| TTY Users: | (711)- |
If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Citations & References
- UnitedHealthcare, http://www.UHCMedicareSolutions.com, Last Accessed October 15, 2022
- Medicare.gov, "Types of Medicare Advantage Plans", Last Accessed January 21, 2023
- Medicare.gov, "Your Medicare Choices", Last Accessed January 4, 2023
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed November 1, 2022
- Medicare.gov, "Your Medicare Coverage", Last Accessed September 11, 2022
- CMS.gov, Landscape Source Files, Last Accessed January 26, 2023
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 26, 2023
- CMS.gov, Plan Benefits Package, Last Accessed January 26, 2023
The Medicare Advantage plan information on this page was last updated on .