UnitedHealthcare Senior Care Options NHC (D-SNP HMO), Franklin County, MA
UnitedHealthcare Senior Care Options NHC (Plan ID: H2226-003) is a 2023 Medicare Special Needs Plan (D-SNP) for people who live in Franklin County, Massachusetts. This UnitedHealthcare HMO plan is required to provide all of the same benefits as Original Medicare and includes some additional benefits, but out-of-pocket costs may be different.
This plan is rated 4.0 (Good) stars by CMS.
GET NOTIFIED: 2024 Medicare Special Needs Plan Notification.
What You Need to Know
- UnitedHealthcare Senior Care Options NHC is a HMO health plan for dual-eligible (Medicare and Medicaid) 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 A and Part B, you must live in the plan's service area (Franklin County), and you must qualify for full Medicaid.
- It includes prescription drug coverage (Medicare Part D).
- 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 copayments.
- 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 Senior Care Options NHC, you might want to compare Medicare Advantage plans available in Franklin County, Massachusetts. Another popular option is to add one of the many Medicare supplements available in Massachusetts and a stand-alone prescription drug plan.
- 2024 costs and benefits for UnitedHealthcare Senior Care Options NHC will be available in early October. Get Notification.
| H2226-003-0 Plan Basics | |
|---|---|
| Plan ID: | H2226-003-0 |
| Plan Type: | D-SNP |
| Network Type: | HMO |
| Plan Year: | 2023 |
| Premium: | $17.80/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $8,300 In-network |
| Drug Plan Benefit: | Basic $505.00 deductible |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Franklin County, MA |
| Insured By: | UnitedHealthcare |
Health Plan Costs & Benefits
UnitedHealthcare Senior Care Options NHC is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, UnitedHealthcare Senior Care Options NHC does allow out-of-network care for emergencies and out-of-area dialysis.
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 Senior Care Options NHC's total monthly premium in Franklin County is $17.80. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
Annual Deductible
UnitedHealthcare Senior Care Options NHC'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 | $0 copay |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Outpatient group therapy visit with a psychiatrist | $0 copay (authorization required) |
| Inpatient hospital - psychiatric | $0 copay (authorization required) |
| Outpatient individual therapy visit with a psychiatrist | $0 copay (authorization required) |
| Outpatient group therapy visit | $0 copay (authorization required) |
| Rehabilitation Services | |
| Physical therapy and speech and language therapy visit | $0 copay (authorization required) |
| Medical Equipment / Supplies | |
| Durable medical equipment (e.g., wheelchairs, oxygen) | $0 copay (authorization required) |
| Diabetes supplies | $0 copay (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Diagnostic radiology services (e.g., MRI) | $0 copay (authorization required) |
| Outpatient x-rays | $0 copay (authorization required) |
| Lab services | $0 copay (authorization required) |
| Medicare Part B Drugs | |
| Other Part B drugs | $0 copay (authorization required) |
| Foot Care (podiatry Services) | |
| Routine foot care | Not covered |
| Hearing | |
| Hearing aids - outer ear | Not covered |
| Hearing aids - over the ear | Not covered |
| Hearing exam | $0 copay (authorization required) |
| Fitting/evaluation | Not covered |
| Preventive Dental | |
| Dental x-ray(s) | Not covered |
| Fluoride treatment | Not covered |
| Cleaning | Not covered |
| Comprehensive Dental | |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
| Non-routine services | Not covered |
| Extractions | Not covered |
| Endodontics | Not covered |
| Diagnostic services | Not covered |
| Periodontics | Not covered |
| Vision | |
| Eyeglass lenses | Not covered |
| Contact lenses | $0 copay (limits may apply) |
| Eyeglass frames | Not covered |
| Other | Not covered |
| Upgrades | Not covered |
| Routine eye exam | $0 copay (authorization required, limits may apply) |
| Emergency Care / Urgent Care | |
| Emergency | $0 copay |
| Ground ambulance | $0 copay |
| Inpatient hospital coverage | $0 copay |
| Outpatient hospital coverage | $0 copay |
| Skilled Nursing Facility | $0 copay |
| Optional supplemental benefits | No |
Feel free to download our UnitedHealthcare Senior Care Options NHC Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
UnitedHealthcare Senior Care Options NHC 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 Services, 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 subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $17.80 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $17.80 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $4.40 |
| Part D Premium with 50% LIS Assistance: | $8.90 |
| Part D Premium with 25% LIS Assistance: | $13.30 |
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 Senior Care Options NHC 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. | ||
Our Review & 2023 CMS Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage D-SNP's in nine broad categories. MedicareWire does not recommend joining a plan with an overall rating of less than 3.0. (3 stars)
This Medicare Advantage D-SNP plan is way better than average. Here's how we can make this claim. In MedicareWire's opinion, UnitedHealthcare Senior Care Options NHC does an excellent job keeping its plan members healthy through its preventive care program with proactive 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. When it comes to complaints and changes in performance, this plan gets the highest marks. If you're concerned about how this health plan will treat you when you call for assistance, don't be. Members say it's good.
| 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 Senior Care Options NHC
To qualify for enrollment in UnitedHealthcare Senior Care Options NHC in Franklin County, 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 Massachusetts's state thresholds.
Before enrolling in UnitedHealthcare Senior Care Options NHC, 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 formulary? 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 that might be worth reviewing:
Contact UnitedHealthcare
Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent (Mon-Fri, 8am-9pm , Sat 8am-8pm EST) and learn more about this Special Needs Plan and other plans on this site. You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
| Plan Website: | http://www.UHCCommunityPlan.com |
|---|---|
| Formulay Information: | http://www.UHCCommunityPlan.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.UHCCommunityPlan.com, Last Accessed October 13, 2022
- Medicaid.gov, "Medicaid & CHIP in Massachusetts", 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