UnitedHealthcare Dual Complete (D-SNP HMO-POS) 2023 Evangeline Parish, Louisiana Medicare Advantage Special Needs Plan
UnitedHealthcare Dual Complete is a 2023 Medicare Special Needs Plan (D-SNP) for people who live in Evangeline Parish, Louisiana. 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 4.0 (Good) out of 5 stars.
Key Takeaways
- UnitedHealthcare Dual Complete is a HMO-POS health plan for dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.... (Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.) beneficiaries.
- This is a zero-dollar D-SNP cost-sharing plan. Members have no copays when they use Medicare-approved healthcare services.
- To qualify, 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, you must live in the plan's service area (Evangeline Parish), and you must qualify for full Medicaid.
- 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 annual Part D deductible is $505.00. You pay this amount before cost-sharing begins.
- People who qualify for Medicare "Extra Help," can get additional assistance to help pay their Medicare Part D monthly premium, deductible, and copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service..
- The plan offers the same health insurance benefits as Original Medicare and some additional benefits that Original Medicare does not cover.
- If you don't qualify to join UnitedHealthcare Dual Complete, you might want to compare 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). available in Evangeline Parish, Louisiana. Another popular option is to add one of the many Medicare supplementsMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. available in Louisiana and a stand-alone prescription drug plan.
| Plan Basics | |
|---|---|
| Plan ID: | H5008-010-0 |
| Plan Type: | D-SNP |
| Network Type: | HMO-POS |
| Plan Year: | 2023 |
| Premium: | $38.40/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $8,300 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: | Basic $505.00 deductible |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | Evangeline Parish, LA |
| Insured By: | UnitedHealthcare |
Health Plan Costs & Benefits
UnitedHealthcare Dual 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 Dual Complete's total monthly premium in Evangeline Parish is $38.40. 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 Dual 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 $8,300 in-network. 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) | $8,300 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) | $0 copay (authorization required) |
| Outpatient group therapy visit with a psychiatrist (In-Network) | $0 copay (authorization required) |
| Outpatient group therapy visit (In-Network) | $0 copay (authorization required) |
| Inpatient hospital - psychiatric (Out-of-Net) | Not Applicable (authorization required) |
| Inpatient hospital - psychiatric (In-Network) | $0 copay (authorization required) |
| Rehabilitation Services | |
| Occupational therapy visit (In-Network) | $0 copay (authorization required) |
| Medical Equipment / Supplies | |
| Prosthetics (e.g., braces, artificial limbs) (In-Network) | $0 copay (authorization required) |
| Diabetes supplies (In-Network) | $0 copay (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Outpatient x-rays (In-Network) | $0 copay (authorization required) |
| Diagnostic radiology services (e.g., MRI) (In-Network) | $0 copay (authorization required) |
| Lab services (In-Network) | $0 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 | |
| Chemotherapy (In-Network) | $0 copay (authorization required) |
| Foot Care (podiatry Services) | |
| Routine foot care (In-Network) | $0 copay (authorization required, limits may apply) |
| Hearing | |
| Hearing aids (In-Network) | $0 copay (authorization required, limits may apply) |
| Hearing exam (In-Network) | $0 copay (authorization required) |
| Preventive Dental | |
| Cleaning (In-Network) | $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) |
| Dental x-ray(s) (Out-of-Net) | $0 copay (limits may apply) |
| Fluoride treatment (Out-of-Net) | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Restorative services (In-Network) | $0 copay (authorization required, limits may apply) |
| Periodontics (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Non-routine services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Endodontics (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) |
| Extractions (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Endodontics (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Diagnostic services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Non-routine services (In-Network) | $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) |
| Extractions (In-Network) | $0 copay (authorization required, limits may apply) |
| Diagnostic services (In-Network) | $0 copay (authorization required, limits may apply) |
| Vision | |
| Eyeglasses (frames and lenses) | Not covered |
| Eyeglass frames (In-Network) | $0 copay (limits may apply) |
| Upgrades | Not covered |
| Routine eye exam (In-Network) | $0 copay (authorization required, limits may apply) |
| Eyeglass lenses (In-Network) | $0 copay (limits may apply) |
| Other | Not covered |
| Emergency Care / Urgent Care | |
| Emergency | $0 copay |
| Ground ambulance | $0 copay |
| Inpatient hospital coverage | $0 copay |
| Outpatient hospital coverage | $0 copay |
| Skilled Nursing Facility | Not Applicable |
| Optional supplemental benefits | No |
Feel free to download our UnitedHealthcare Dual Complete Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
UnitedHealthcare Dual Complete includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by 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., whereas enhanced benefit plans cover more.
Basic plans typically have less cost-sharing by the plan than plans with an enhanced benefit. But, close to a third of all enhanced plans charge more than the average for preferred brand name drugs, and over 50% charge more for non-preferred brand drugs. For most people, a basic plan is their best bet, due to lower premiums and lower cost-sharing, even if the plan has a deductible.
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: | $38.40 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $38.40 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $9.60 |
| Part D Premium with 50% LIS Assistance: | $19.20 |
| Part D Premium with 25% LIS Assistance: | $28.80 |
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 $505.00. 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 Dual 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 |
|---|---|---|
| $0 copay on all covered generic and brand-name prescriptions. | ||
CMS Rating Marks and Our Review
Each year Medicare rates D-SNP plans, like this one, in nine major categories. These ratings are designed to help you understand the quality of care and service you can expect if you qualify and choose to join UnitedHealthcare Dual Complete.
In terms of quality care, this D-SNP is way better than the average Medicare Advantage plan in Louisiana. From MedicareWire's perspective, UnitedHealthcare Dual Complete does an average job keeping plan members healthy through preventive care measures, 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 performance with this plan are average. 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 Dual Complete
To qualify for enrollment in UnitedHealthcare Dual Complete in Evangeline Parish, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below Louisiana's state thresholds.
Before enrolling in UnitedHealthcare Dual Complete, or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's 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.? What if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans in Evangeline Parish (D-SNPs) that might be worth reviewing:
- Humana Gold Plus SNP-DE H1951-041
- Humana Gold Plus SNP-DE H1951-057
- Healthy Blue Dual Advantage
- Peoples Health Secure Complete
- UnitedHealthcare Dual Complete Choice
Contact UnitedHealthcare
| Plan Website: | http://www.UHCMedicareSolutions.com |
|---|---|
| Formulay Information: | http://www.UHCMedicareSolutions.com |
| Pharmacy Information: | UnitedHealthcare Pharmacy Page |
| Prospective Members: | (888)834-3721 |
| 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 13, 2022
- Medicaid.gov, "Medicaid & CHIP in Louisiana", Last Accessed January 20, 2023
- CMS.gov, "Dual Eligible Special Needs Plans (D-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 Evangeline Parish, Louisiana for 2023 information on this page was last updated on .