UHC Complete Care TC-0005 (HMO-POS C-SNP) (2024)

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Footnotes

¹NOTE: Only applies to plans with prescription drug coverage.

Savings benefit

Savings apply during the Initial Coverage period, which begins after the payment of your required deductible (if any) and ends when the total cost of your drugs (paid by UnitedHealthcare, you and others) reaches $5,030 (2024).

Optum Rx and Optum Home Delivery Pharmacy are affiliates of UnitedHealthcare Insurance Company. You are not required to use Optum Home Delivery Pharmacy for your regular medication. There may be other pharmacies in our network. If you have not used Optum Home Delivery Pharmacy, you must approve the first prescription order sent directly from your doctor to Optum Rx before it can be filled. New prescriptions from the pharmacy should arrive within ten business days from the date the completed order is received, and refill orders should arrive in about seven business days. Contact Optum Rx anytime at 1-877-266-4832 / TTY 711, 8 a.m. to 8 p.m., 7 days a week.

$0 copays may be restricted to preferred home delivery prescriptions during the initial coverage phase and may not apply during the coverage or catastrophic stage. Benefits vary by plan/area. Limitations and exclusions apply.

Disclaimer information
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Dental, Ancilliary Mention:

Provider network may vary in local market. Dental network size based on Zelis Network360, May 2023.

D-SNP Disclaimer, State-Level Medicare:
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D-SNP and C-SNP:The values shown in-network represent a range based upon the amount of the Medicare Parts A and B plan cost sharing covered by the state. Depending on your Medicaid eligibility, your Medicaid program may have cost sharing. For complete information, and for costs for those without Medicare Parts A and B plan cost sharing covered by the state, and applicable Medicaid cost sharing, please refer to your Summary of Benefits or Evidence of Coverage. Limitations, exclusions, and restrictions may apply.

Enrollment Disclaimer Information:
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Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare. UnitedHealthcare Insurance Company paid royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll. AARP encourages you to consider your needs when selecting products and does not make specific product or pharmacy recommendations for individuals. UnitedHealthcare contracts directly with Walgreens for this plan; AARP and its affiliates are not parties to that contractual relationship.

Extra Help:
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If you receive Extra Help from Medicare, your copays may be lower or you may have no copays.

Marketing Bullets:

- Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

-Nurse Hotline not for use in emergencies, for informational purposes only.

-Other hearing exam providers are available in the UnitedHealthcare network. The plan only covers hearing aids from a UnitedHealthcare Hearing network provider.

-For Chronic Special Needs Plans - You will pay a maximum of $25 for each 1-month supply of Part D covered insulin drug through all coverage stages, except the Catastrophic drug payment stage where you pay $0.

-For All Other Plans - You will pay a maximum of $35 for each 1-month supply of Part D covered insulin drug through all coverage stages, except the Catastrophic drug payment stage where you pay $0.

-Food, OTC and utility benefits have expiration timeframes. Call your plan or review your Evidence of Coverage (EOC) for more information.

-You must have a working landline and/or cellular phone coverage to use PERS.

-The fitness benefit includes a standard fitness membership. The information provided is for informational purposes only and is not medical advice. Consult your doctor prior to beginning an exercise program or making changes to your lifestyle or health care routine. Gym network may vary in local market and plan.

-If your plan offers out-of-network dental coverage and you see an out-of-network dentist, you might be billed more. Network size varies by local market.

Footnotes

¹NOTE: Only applies to plans with prescription drug coverage.

Disclaimer information
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Enrollment Disclaimer Information:
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Extra Help:
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If you receive Extra Help from Medicare, your copays may be lower or you may have no copays.

The Medicare Prescription Payment Plan:
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Other Languages:
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This information is available for free in other languages. PleasecontactCustomer Service for additional information. 

Esta información está disponible sin costo en otros idiomas. Para obtener más informacióncomuníquesecon nuestro Servicio al Cliente. 
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本資訊可以其他語言免費提供。如需更多資訊，請聯絡客戶服務部。 
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Find out about this plan’s copays for primary care providers and specialists.

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Important documents that provide the details you need about this plan's coverage and benefits, prescription drugs, enrollment, providers and more.

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Learn about this plan’s dental coverage options and costs.

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See this plan's benefits, costs and copays. For full plan details, see the Evidence of Coverage orSummary of Benefits under the Plan Documents section.

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Learn about this plan's prescription drug coverage and costs. Enter your prescriptions to see what they'd cost with this plan.

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See how much you'll pay for this plan including your premium, deductible and maximum out-of-pocket costs.

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See more of the benefits and programs offered by this plan that are not provided under Original Medicare. For full plan details, see the Evidence of Coverage or Summary of Benefits under the Plan Documents section.

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Learn more about what you pay, what this plan covers and how we can help you find the right plan.

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here to help","getHelp":"Get one-on-one help from UnitedHealthcare.","daysAWeek":"8 a.m. to 8 p.m., 7 days a week","tty":"/ TTY 711","findASalesAgent":"Find a sales agent in your area","illustrationSupport":"/content/dam/commontools/vpp/redesign/images/illustration-support-rgb-full@2x.png"},"isnp":{"call":"Call","externalLinkIcon":"/content/dam/commontools/vpp/redesign/icons/external-blue-icon@2x.png","wereHereToHelp":"We're here to help","getHelp":"Get one-on-one help from UnitedHealthcare.","daysAWeek":" 7 a.m. to 7 p.m., 7 days a week","tty":"/ TTY 711","findASalesAgent":"Find a sales agent in your area","illustrationSupport":"/content/dam/commontools/vpp/redesign/images/illustration-support-rgb-full@2x.png","tfn":"/content/dam/MRD/content-fragments/common-tools-vpp/global/enroll-by-phone"},"iesnp":{"call":"Call","externalLinkIcon":"/content/dam/commontools/vpp/redesign/icons/external-blue-icon@2x.png","wereHereToHelp":"We're here to help","getHelp":"Get one-on-one help from 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What is an HMO? Medicare Health Maintenance Organization (HMO) plans cover care you receive through a network of local doctors and hospitals that coordinate your care.

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What is PPO? Preferred Provider Organization (PPO) plans allow you to visit providers who are in or out of the plan's network. For services received outside of the network, you generally have higher copayment and coinsurance costs.

\n"},"pos":{"DSNP":false,"hideplansummary":false,"HMOPOS":true,"hideplandetails":true,"PFFS":false,"hideplancompare":true,"HMO":false,"CSNP":false,"PPO":false,"ISNP":false,"tooltipvalue":"

What is HMO-POS? A type of HMO plan, Point of Service (POS) plans let you receive certain services from doctors or hospitals that are not in the plans network, generally at a higher copayment or coinsurance.

\n"},"pffs":{"DSNP":false,"hideplansummary":false,"HMOPOS":false,"hideplandetails":true,"PFFS":true,"hideplancompare":true,"HMO":false,"CSNP":false,"PPO":false,"ISNP":false,"tooltipvalue":"

What is PFFS? A Private Fee-for-Service (PFFS) plan is a Medicare Advantage plan that can be a network or non-network plan. UnitedHealthcare only offers non-network PFFS plans, which give members the freedom to use any Medicare-eligible doctor or hospital who agrees to accept the plan's terms and conditions of payment. No referrals or prior authorizations are required for covered services.

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What is an HMO? Medicare Health Maintenance Organization (HMO) plans cover care you receive through a network of local doctors and hospitals that coordinate your care.

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\n"}},"toolTipConfig":{"master":{"hideplansummary":false,"hideplandetails":false,"hideplancompare":false},"select_insulin_drugs":{"benefitname":"Insulin Demo (M118)","hideplansummary":true,"hideplandetails":true,"hideplancompare":true,"tooltipvalue":"

For Chronic Special Needs plans: You will pay a maximum of $25 for each 1-month supply of Part D select insulin drug through all coverage stages. For all other plans: You will pay a maximum of $35 for each 1-month supply of Part D covered insulin drug through all coverage stages.

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UHC Complete Care TC-0005 (HMO-POS C-SNP)

Monthly premium: $0

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Monthly premium
^$0
$0

Primary care provider (PCP)
^$0 copay
$0 copay

Out-of-pocket maximum
^$4,900
$4,900

Estimated Annual Drug Cost

Discover the Benefits

Low cost insulin
$25 or less for 1-month supply of covered insulin

Food and OTC Credit
$50 credit every month to pay for healthy food and OTC products in-store or online

Dental benefits
$2,000 dental allowance for covered preventive and comprehensive services like cleanings, fillings and crowns

Eligibility

Special eligibility requirement ⁴	Must be diagnosed with diabetes, chronic heart failure, and/or a cardiovascular disorder.
Special eligibility requirement ⁴ Must be diagnosed with diabetes, chronic heart failure, and/or a cardiovascular disorder.Must be diagnosed with diabetes, chronic heart failure, and/or a cardiovascular disorder.

General plan costs

See how much you'll pay for this plan including your premium, deductible and maximum out-of-pocket costs.

Costs	What you'll pay
Monthly premium	$0
Monthly premium $0$0
Annual medical deductible Annual medical deductible The pre-set, fixed amount you must pay for health care costs before the insurance company or Medicare begins to pay. Please see your Evidence of Coverage for details. x Close Popup	No deductible
Annual medical deductible Annual medical deductible The pre-set, fixed amount you must pay for health care costs before the insurance company or Medicare begins to pay. Please see your Evidence of Coverage for details. x Close Popup No deductibleNo deductible
Out-of-pocket maximum Out-of-pocket maximum This is the highest amount of money you have to pay out of your pocket for cost sharing (copayments and coinsurance) charged for certain covered services during a calendar year. Not all copayments or coinsurance amounts you pay apply toward the annual out-of-pocket maximum. See the plan’s Evidence of Coverage for more information. x Close Popup	$4,900
Out-of-pocket maximum Out-of-pocket maximum This is the highest amount of money you have to pay out of your pocket for cost sharing (copayments and coinsurance) charged for certain covered services during a calendar year. Not all copayments or coinsurance amounts you pay apply toward the annual out-of-pocket maximum. See the plan’s Evidence of Coverage for more information. x Close Popup $4,900
National Network National Network As a member of an eligible health plan, the UnitedHealthcare Medicare National Network allows you to have access to participating care providers across the United States at your in-network cost share, even when getting care outside of your home location. Networks vary by market and exclusions may apply. x Close Popup	Yes, you can get network care across the country
National Network National Network As a member of an eligible health plan, the UnitedHealthcare Medicare National Network allows you to have access to participating care providers across the United States at your in-network cost share, even when getting care outside of your home location. Networks vary by market and exclusions may apply. x Close Popup Yes, you can get network care across the countryYes, you can get network care across the country

Doctor visits

Find out about this plan’s copays for primary care providers and specialists.

Prescription drug benefits

Learn about this plan's prescription drug coverage and costs. Enter your prescriptions to see what they'd cost with this plan.

Dental coverage

Learn about this plan’s dental coverage options and costs.

Medical benefit information

See this plan's benefits, costs and copays. For full plan details, see the Evidence of Coverage orSummary of Benefits under the Plan Documents section.

Extra benefits and programs

Plan documents

Important documents that provide the details you need about this plan's coverage and benefits, prescription drugs, enrollment, providers and more.

UHC Complete Care TC-0005 (HMO-POS C-SNP) (2024)

Footnotes

Disclaimer information\n

Footnotes

1NOTE: Only applies to plans with prescription drug coverage.

Disclaimer information\n

Discover the Benefits

Low cost insulin

Food and OTC Credit

Dental benefits

Eligibility

General plan costs

Doctor visits

Prescription drug benefits

Dental coverage

Medical benefit information

Extra benefits and programs

Plan documents

Footnotes & disclaimers

We're here to help

Call

/ TTY 711

References

Disclaimer information
\n

¹NOTE: Only applies to plans with prescription drug coverage.

Disclaimer information
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