AARP Medicare Advantage Patriot No Rx SI-MA01 (PPO) Plan Details for Fall River County, SD
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*CMS rated this UnitedHealthcare plan (H1278-019-0) 4 (Good) out of 5 stars.
AARP Medicare Advantage Patriot No Rx SI-MA01 (PPO) is a Medicare Advantage plan with a prescription drug plan. The 2025 Annual Enrollment period starts October 15. Plan benefits
See more Medicare Advantage Plans in Fall River County, South Dakota.
AARP Medicare Advantage Patriot No Rx SI-MA01 Basic Details
| Plan Basics | |
|---|---|
| Plan ID: | H1278-019-0 |
| Plan Type: | PPO |
| Plan Year: | 2025 |
| Premium: | $0.00/mo Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | 6,700.00 /yr (in-network) |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | Not Included |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Fall River County, SD |
| Insured By: | UnitedHealthcare |
| Summary of Benefits |
|---|
UnitedHealthcare Out-of-Pocket Costs
This UnitedHealthcare Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H1278-019-0.
NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.
Doctor's Office Visits
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $50 Copay Prior Authorization Required |
Emergency, Urgent, and Inpatient Hospital Coverage
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $125 Copay |
| Urgent care: | $55 Copay |
| Ground ambulance: | $290 Copay |
| Inpatient hospital care: | $445.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 and beyond |
Foot Care
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $45 Copay Prior Authorization Required |
| Routine Foot Care: | $45 Copay Prior Authorization Required |
Chiropractic Care
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $20 Copay Prior Authorization Required |
| Routine chiropractic: | Not Covered |
Mental Health Services
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $10 Copay |
| Outpatient group therapy: | $10 Copay |
| Inpatient psychiatric hospital care: | $445.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Rehabilitation Services
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $50 Copay Prior Authorization Required |
| Occupational therapy: | $45 Copay Prior Authorization Required |
Medical Equipment and Supplies
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay Prior Authorization Required |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $250 Copay Prior Authorization Required |
| Lab services: | $0 Copay Prior Authorization Required |
| Outpatient x-rays: | $25 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $20 Copay Prior Authorization Required |
Medicare Part B Drugs
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
Dental Services
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | 20% Coinsurance Prior Authorization Required |
| Oral exam | $0 Copay |
| Dental x-rays | $0 Copay |
| Cleaning | $0 Copay |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
| Maximum dental benefit: | $1,000.00 (Every year) |
Hearing Aids and Services
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Not Covered |
Vision Services
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam | $0 Copay |
| Routine eye exam | $0 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: No Contact Lenses: No Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $2.00 Every three years |
Feel free to download our AARP Medicare Advantage Patriot No Rx SI-MA01 Summary of Benefits information.
Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) and drug plans (Part D) in several major categories using a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join AARP Medicare Advantage Patriot No Rx SI-MA01 .
| CMS Measure | Star Rating |
|---|---|
| 2025 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 Plan Options
The Medicare Part C program offers a myriad of HMO, PPO, and PFFS plan options, including these plans:
- AARP Medicare Advantage Giveback from UHC TX-31 (PPO)
- AARP Medicare Advantage from UHC WA-0003 (PPO)
- AARP Medicare Advantage Giveback from UHC TX-32 (PPO)
- AARP Medicare Advantage Patriot No Rx NE-MA01 (PPO)
- AARP Medicare Advantage from UHC NE-0002 (PPO)
- AARP Medicare Advantage from UHC TX-0033 (PPO)
- AARP Medicare Advantage from UHC SI-0001 (PPO)
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Contact UnitedHealthcare
| Website: | UnitedHealthcare Plan Page |
|---|---|
| Providers: | UnitedHealthcare Providers Page |
| New Member Health Plan Help: | (800)555-5757 |
| New Member Health Plan TTY: | 711 |
If you qualify for Medicare benefits 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 Part C program on www.medicare.gov or call 1-800-MEDICARE.
Citations & References
- UnitedHealthcare, http://AARPMedicarePlans.com, Last Accessed February 20, 2024
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed February 19, 2024
- Medicare.gov, "Is Your Test, Item, or Service Covered?", Last Accessed June 3, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.