H0609-042-0: UnitedHealthcare Chronic Complete C-SNP Details
UnitedHealthcare Chronic Complete, plan H0609-042-0, is a C-SNP Medicare Advantage plan, by UnitedHealthcare. It has a HMO-POS provider network. This UnitedHealthcare HMO-POS 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.
CMS rated this plan 3.5 (Above Average) out of 5 stars. See MedicareWire's review below. You must meet all qualification requirements to join this C-SNP plan.
GET NOTIFIED: 2024 Medicare Special Needs Plan Notification.
What You Need to Know
- 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 A and Part B, and you must live in the plan's service area ( County).
- The plan has a HMO-POS provider network, and it includes prescription drug coverage (Medicare Part D).
- 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. Review the "Health Plan Costs & Benefits" section below for the most used services.
- 2024 costs and benefits for UnitedHealthcare Chronic Complete will be available in early October. Get Notification.
| H0609-042-0 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-network |
| Drug Plan Benefit: | Enhanced $0.00 deductible |
| Rx Gap Coverage: | Yes |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | See List |
| 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 deductibles for in-network and out-of-network services.
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 County is $0.00. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
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 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) | $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 equipment (e.g., wheelchairs, oxygen) (In-Network) | 20% coinsurance 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 B 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 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: | $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 Services (CMS) rates Medicare Advantage C-SNP's in nine broad categories. MedicareWire does not recommend joining a plan with an overall rating of less than 3.0. (3 stars)
In terms of quality, this 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 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 disease
- 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
This plan is for individuals with chronic alcohol and other drug dependence.
Plan Availability
UnitedHealthcare Chronic Complete (H0609-042-0) is available in the following locations (click to open):
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- H0609-049-0: UnitedHealthcare Chronic Complete Focus (C-SNP)
- H0609-042-0: UnitedHealthcare Chronic Complete (C-SNP)
- H0609-037-0: UnitedHealthcare Medicare Advantage Assist (C-SNP)
- H0609-043-0: UnitedHealthcare Chronic Complete (C-SNP)
- H0609-047-0: UnitedHealthcare Chronic Complete (C-SNP)
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.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.
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.AARPMedicarePlans.com, Last Accessed October 13, 2022
- Medicaid.gov, "Medicaid & CHIP in ", 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