UnitedHealthcare Chronic Complete (C-SNP HMO-POS) 2023 Maricopa County, Arizona Medicare Advantage Special Needs Plan
UnitedHealthcare Chronic Complete is a 2023 Medicare Special Needs Plan (C-SNP) for people who live in Maricopa County, Arizona. This UnitedHealthcare HMO-POS plan is required to provide all of the same benefits as 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. and includes some additional benefits, but 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. may be different.
CMS rated this plan 3.5 (Above Average) out of 5 stars.
Key Takeaways
- UnitedHealthcare Chronic Complete is a non-government health plan that restricts enrollment to special needs individuals with specific severe or disabling chronic conditions.
- This plan is for individuals with chronic alcohol and other drug dependence.
- In addition to the chronic health condition(s) above, you must have both 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, and you must live in the plan's service area (Maricopa County).
- The plan has a HMO-POS provider network and it includes prescription drug coverage (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...).
- The Part D plan does not have an annual deductible. Cost-sharing begins with your first prescription.
- As required, UnitedHealthcare Chronic Complete has the same core benefits as Original Medicare, but offers additional benefits not available in Original Medicare.
- The out-of-pocket costs with this plan are different than Original Medicare, and in some cases may be higher. Carefully review the "Health Plan Costs & Benefits" section below for the services you use most.
| Plan Basics | |
|---|---|
| Plan ID: | H0609-042-0 |
| Plan Type: | C-SNP |
| Network Type: | HMO-POS |
| Plan Year: | 2023 |
| Premium: | $0.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $2,500 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... |
| Drug Plan Benefit: | Enhanced $0.00 deductible |
| Rx Gap Coverage: | Yes |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | Maricopa County, AZ |
| Insured By: | UnitedHealthcare |
Health Plan Costs & Benefits
UnitedHealthcare Chronic Complete is an HMO-POS (point-of-sale) plan. HMO-POS plans offer the same features as a Health Maintenance Organization (HMO) plan, however, there is one major difference. HMO-POS plans allow members to access healthcare providers outside the plan's network to receive some or all of their services. In most cases, a member will need to get a referral from their physician to go out of the plan's network. Plus, there are separate deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. for in-network and out-of-network services.
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. , 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 Chronic Complete's total monthly premium in Maricopa County is $0.00. 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....
Annual Deductible
UnitedHealthcare Chronic Complete'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 $2,500 in-network. Unlike Original Medicare, 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). 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 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) | $2,500 In-network |
| Doctor Visits | |
| Primary (In-Network) | $0 copay |
| 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) |
| Inpatient hospital - psychiatric (In-Network) | $175 per day for days 1 through 7 $0 per day for days 8 through 90 (authorization required) |
| Outpatient group therapy visit with a psychiatrist (In-Network) | $15 copay (authorization required) |
| Inpatient hospital - psychiatric (Out-of-Net) | Not Applicable (authorization required) |
| Outpatient group therapy visit (In-Network) | $15 copay (authorization required) |
| Rehabilitation Services | |
| Occupational therapy visit (In-Network) | $10 copay (authorization required) |
| Medical Equipment / Supplies | |
| 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% coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. per item (authorization required) |
| Diabetes supplies (In-Network) | $0 copay 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 tests and procedures (In-Network) | $30 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) | |
| Routine foot care (In-Network) | $10 copay (authorization required, limits may apply) |
| Hearing | |
| Fitting/evaluation | Not covered |
| Hearing aids (In-Network) | $175-1,225 copay (authorization required, limits may apply) |
| Preventive Dental | |
| Dental x-ray(s) (Out-of-Net) | $0 copay (limits may apply) |
| Oral exam (Out-of-Net) | $0 copay (limits may apply) |
| Fluoride treatment (In-Network) | $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) |
| Oral exam (In-Network) | $0 copay (limits may apply) |
| Cleaning (In-Network) | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Non-routine services (In-Network) | $0 copay (authorization required, limits may apply) |
| Non-routine services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Endodontics (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Periodontics (In-Network) | $0 copay (authorization required, limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Restorative services (In-Network) | $0 copay (authorization required, limits may apply) |
| Periodontics (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Extractions (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Diagnostic services (In-Network) | $0 copay (authorization required, limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | $0 copay (authorization required, limits may apply) |
| Endodontics (In-Network) | $0 copay (authorization required, limits may apply) |
| Extractions (In-Network) | $0 copay (authorization required, limits may apply) |
| Restorative services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Vision | |
| Other | Not covered |
| Eyeglasses (frames and lenses) (In-Network) | $0 copay (limits may apply) |
| Eyeglass lenses | Not covered |
| Eyeglass frames | Not covered |
| Routine eye exam (In-Network) | $0 copay (authorization required, limits may apply) |
| Contact lenses (In-Network) | $0 copay (limits may apply) |
| Emergency Care / Urgent Care | |
| Urgent care | $40 copay per visit (always covered) |
| Ground ambulance | $250 copay |
| Inpatient hospital coverage | $175 per day for days 1 through 7 $0 per day for days 8 through 90 $0 per day for days 91 and beyond |
| Outpatient hospital coverage | $0-175 copay per visit |
| Skilled Nursing Facility | Not Applicable |
| Optional supplemental benefits | No |
Feel free to download our UnitedHealthcare Chronic Complete Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
UnitedHealthcare Chronic Complete 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 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: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $0.00 |
| Part D Premium with 50% LIS Assistance: | $0.00 |
| Part D Premium with 25% LIS Assistance: | $0.00 |
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 Chronic Complete 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 | $45.00 copay |
| 4 (Non-Preferred Drug) | N/A | $95.00 copay |
| 5 (Specialty Tier) | N/A | 33% |
A Brief Review and CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid ServicesThe Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs. (CMS) rates Medicare Advantage C-SNP's in nine broad categories. MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. does not recommend joining a plan with an overall rating of less than 3.0. (3 stars)
In terms of quality, this Arizona C-SNP plan is just average. Staying healthy is the best way to save money on health care, and in MedicareWire's judgement, UnitedHealthcare Chronic Complete 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. Members report that their experience with this C-SNP plan is below 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.
| 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 |
How to Qualify to Enroll in
UnitedHealthcare Chronic Complete
To be eligible to enroll in UnitedHealthcare Chronic Complete, you must meet these requirements:
- You are eligible for Medicare;
- You live in Maricopa County (the plan’s service area); and
- You have been diagnosed with one or more severe or disabling chronic conditions.
A disabiling chronic condition (disease) is one that lasts one or more years and requires ongoing medical attention and/or limits activities of daily living. They include:
- Autoimmune disorders
- End-stage renal diseaseEnd-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age.
- Cancer
- Cardiovascular disorders
- Hematologic disorders
- HIV/AIDS
- Chronic heart failure
- Chronic lung disorders
- Neurologic disorders
- Dementia
- Diabetes
- End-stage liver disease
- Neurologic disorders
- Stroke
- Mental health conditions
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans in Maricopa County (C-SNPs) that might be worth reviewing:
Contact UnitedHealthcare
| Plan Website: | http://www.AARPMedicarePlans.com |
|---|---|
| Formulay Information: | http://www.AARPMedicarePlans.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.AARPMedicarePlans.com, Last Accessed October 13, 2022
- MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States..gov, "Medicaid & CHIP in Arizona", Last Accessed January 20, 2023
- CMS.gov, "Chronic Condition Special Needs Plans (C-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 21, 2023
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 21, 2023
- CMS.gov, Plan Benefits Package, Last Accessed January 21, 2023
The Medicare Special Needs Plans in Maricopa County, Arizona for 2023 information on this page was last updated on .