UnitedHealthcare Medicare Advantage Choice: Henry County, GA PPO Plan
What is Plan R2604-001-0?
UnitedHealthcare Medicare Advantage Choice, plan ID R2604-001-0, is a PPO Medicare Advantage plan, with Part D benefits, available in 2023.
This UnitedHealthcare plan offers the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may also include additional, valuable benefits not covered by Part A or Part B.
Availability: Henry County, Georgia
GET NOTIFIED: 2024 Medicare Advantage Plan Notification.
What You Need to Know
- It is a Preferred Provider Organization (PPO) Medicare Advantage plan.
- It has the same major health insurance benefits as Original Medicare (Parts A and B).
- It offers extra benefits that Medicare Part A and Medicare Part B do not cover.
- This UnitedHealthcare PPO plan allows you to choose your own primary care doctor, specialists, and other healthcare providers. However, be aware that providers in the plan's network cost less.
- The monthly premium is $49.00.
- You must continue to pay your Medicare Part B monthly premium.
- This plan does not offer a Medicare Part B premium reduction (no giveback benefit).
- The out-of-pocket costs are different than Original Medicare (See: "Health Plan Costs & Benefits" below).
- The health plan does not have a deductible.
- The maximum out-of-pocket cost with this plan is $6,700 (in-network).
- UnitedHealthcare Medicare Advantage Choice includes a prescription drug plan (Medicare Part D). The annual Part D deductible is $295.00.
- This plan's Part D Initial Coverage Limit is $4,430 (standard).
- It offers the following supplemental benefits: Vision, Hearing (limitations apply, see below).
- 2024 costs and benefits for UnitedHealthcare Medicare Advantage Choice will be available in early October. Get Notification
| R2604-001-0 Plan Basics | |
|---|---|
| Plan ID: | R2604-001-0 |
| Plan Type: | Regional PPO |
| Plan Year: | 2023 |
| Premium: | $49.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $6,700/yr |
| Part B Reduction:[4] | $0.00/mo |
| Drug Plan Benefit: | Enhanced, $295.00 deductible |
| Rx Gap Coverage: | Yes |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Henry County, GA |
| Insured By: | UnitedHealthcare |
WARNING: It is important to understand that many private health plans, like UnitedHealthcare Medicare Advantage Choice, may have higher inpatient costs than Original Medicare. Before enrolling, take the time to evaluate your personal healthcare needs. Get the facts with our free Summary of Benefits download.[3]
Please note that 2024 Medicare Advantage plan information from UnitedHealthcare will not be available until early October.
Health Plan Costs & Benefits
Premiums, deductibles, 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 Choice's total monthly premium in Henry County is $49.00. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
Some Medicare Advantage plans 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 Choice'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 $6,700. Unlike Original Medicare, 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 copayments, all of your Medicare Part A 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 costs 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) | $6,700 In and Out-of-network $6,700 In-network |
| Doctor Visits | |
| Primary (Out-of-Net) | $25-45 copay per visit |
| Specialist (In-Network) | $45 copay per visit (authorization required) |
| Specialist (Out-of-Net) | $45 copay per visit (authorization required) |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Outpatient individual therapy visit (In-Network) | $25 copay (authorization required) |
| Outpatient individual therapy visit (Out-of-Net) | $15-25 copay (authorization required) |
| Inpatient hospital - psychiatric (In-Network) | $395 per day for days 1 through 4 $0 per day for days 5 through 90 (authorization required) |
| Outpatient individual therapy visit with a psychiatrist (Out-of-Net) | $15-25 copay (authorization required) |
| Outpatient group therapy visit with a psychiatrist (In-Network) | $15 copay (authorization required) |
| Outpatient group therapy visit (Out-of-Net) | $15-25 copay (authorization required) |
| Outpatient group therapy visit with a psychiatrist (Out-of-Net) | $15-25 copay (authorization required) |
| Outpatient individual therapy visit with a psychiatrist (In-Network) | $25 copay (authorization required) |
| Outpatient group therapy visit (In-Network) | $15 copay (authorization required) |
| Rehabilitation Services | |
| Physical therapy and speech and language therapy visit (Out-of-Net) | $20 copay (authorization required) |
| Occupational therapy visit (Out-of-Net) | $20 copay (authorization required) |
| Occupational therapy visit (In-Network) | $20 copay (authorization required) |
| Medical Equipment / Supplies | |
| Durable medical equipment (e.g., wheelchairs, oxygen) (Out-of-Net) | $55 copay or 50% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs) (In-Network) | 20% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs) (Out-of-Net) | $55 copay or 50% coinsurance per item (authorization required) |
| Diabetes supplies (In-Network) | $0 copay per item (authorization required) |
| Diabetes supplies (Out-of-Net) | $55 copay or 50% coinsurance per item (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Diagnostic radiology services (e.g., MRI) (In-Network) | $0-175 copay (authorization required) |
| Lab services (In-Network) | $0 copay (authorization required) |
| Diagnostic tests and procedures (In-Network) | $30 copay (authorization required) |
| Diagnostic radiology services (e.g., MRI) (Out-of-Net) | $0-175 copay (authorization required) |
| Lab services (Out-of-Net) | $0 copay (authorization required) |
| Outpatient x-rays (In-Network) | $15 copay (authorization required) |
| Outpatient x-rays (Out-of-Net) | $15 copay (authorization required) |
| Medicare Part B Drugs | |
| Other Part B drugs (In-Network) | 0-20% coinsurance (authorization required) |
| Chemotherapy (In-Network) | 20% coinsurance (authorization required) |
| Chemotherapy (Out-of-Net) | 0-20% coinsurance (authorization required) |
| Foot Care (podiatry Services) | |
| Routine foot care (Out-of-Net) | $45 copay (authorization required, limits may apply) |
| Routine foot care (In-Network) | $45 copay (authorization required, limits may apply) |
| Foot exams and treatment (Out-of-Net) | $45 copay (authorization required) |
| Hearing | |
| Hearing aids (Out-of-Net) | $175-1,225 copay (authorization required, limits may apply) |
| Fitting/evaluation | Not covered |
| Hearing exam (Out-of-Net) | $45 copay (authorization required) |
| Hearing exam (In-Network) | $0 copay (authorization required) |
| Preventive Dental | |
| Fluoride treatment | Not covered |
| Cleaning | Not covered |
| Oral exam | Not covered |
| Comprehensive Dental | |
| Extractions | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
| Periodontics | Not covered |
| Non-routine services | Not covered |
| Diagnostic services | Not covered |
| Endodontics | Not covered |
| Vision | |
| Eyeglasses (frames and lenses) | Not covered |
| Upgrades | Not covered |
| Routine eye exam (In-Network) | $0 copay (authorization required, limits may apply) |
| Eyeglass frames | Not covered |
| Eyeglass lenses | Not covered |
| Other | Not covered |
| Routine eye exam (Out-of-Net) | $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 | $395 per day for days 1 through 4 $0 per day for days 5 through 90 $0 per day for days 91 and beyond |
| Outpatient hospital coverage | $0-395 copay per visit |
| Skilled Nursing Facility | $225 per day for days 1 through 30 $0 per day for days 31 through 100 |
| Optional supplemental benefits | Yes |
Feel free to download our UnitedHealthcare Medicare Advantage Choice Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
UnitedHealthcare Medicare Advantage Choice includes an enhanced benefit Medicare Part D 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 formulary. 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 subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $49.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $49.00 |
| Part D Premium with Full LIS Assistance: | $11.50 |
| Part D Premium with 75% LIS Assistance: | $20.90 |
| Part D Premium with 50% LIS Assistance: | $30.30 |
| Part D Premium with 25% LIS Assistance: | $39.60 |
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 $295.00. This is the amount you must pay at the pharmacy before UnitedHealthcare begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, UnitedHealthcare Medicare Advantage Choice 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 (deductible does not apply) |
| 2 (Generic) | N/A | $14.00 copay |
| 3 (Preferred Brand) | N/A | $47.00 copay |
| 4 (Non-Preferred Drug) | N/A | $100.00 copay |
| 5 (Specialty Tier) | N/A | 28% |
Our Review & 2023 CMS Rating Marks
In terms of quality care, this Medicare Advantage PPO plan is much better than the average plan in areas it serves. Staying healthy is the best way to save money on health care, and UnitedHealthcare Medicare Advantage Choice 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. Medicare beneficiaries enrolled in this UnitedHealthcare plan enjoy a good member experience. 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.
UnitedHealthcare Medicare Advantage Choice offers some vision and hearing benefits, but not dental. With an added premium of $49.00 dollars per month, prospective members are advised to carefully weigh the value of the plan's additional benefits. With a maximum out-of-pocket limit of $6,700 per year, this plan could be costly if you have chronic health conditions. In the event of a 5-day hospital stay, costs will likely be higher than Original Medicare. Even though members have copays with this health plan, they don't have to worry about a deductible.
Each year the Centers for Medicare & Medicaid Services (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. Here are the most recent CMS ratings for this plan:
| 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 Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- Wellcare No Premium Open
- Anthem MediBlue Access Basic
- UnitedHealthcare Medicare Advantage Choice Plan 1
- Clover Health Valor
- AARP Medicare Advantage Choice Rebate
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.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.
Citations & References
- UnitedHealthcare, http://www.UHCMedicareSolutions.com, Last Accessed January 15, 2023
- Medicare.gov, "Your Coverage Options", Last Accessed June 11, 2023
- Medicare.gov, "How Original Medicare Works", Last Accessed May 3, 2023
- Medicare.gov, "Medicare & You", Last Accessed May 25, 2023
- Medicare.gov, "What Medicare Covers", Last Accessed February 7, 2023
- CMS.gov, Landscape Source Files, Last Accessed June 2, 2023
- CMS.gov, Medicare Part C & D Performance, Last Accessed June 2, 2023
- CMS.gov, Plan Benefits Package, Last Accessed June 2, 2023
About This R2604-001-0 Plan Detail Page
The core data on this UnitedHealthcare Medicare Advantage Choice plan detail page is derived from the 2023 Landscape Source Files published by CMS. The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by UnitedHealthcare to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from UnitedHealthcare, at (800)555-5757, prior to enrollment.