UnitedHealthcare Medicare Advantage Assure (PPO) H0271-004-000 2022 Plan Details and Costs (2024)

Basic Costs and Coverage

Coverage	Details
Monthly plan premium	$29.10
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible	$480.00
Out-of-pocket maximum	$7,550.00
Initial drug coverage limit	$4,430.00
Catastrophic drug coverage limit	$7,050.00
Primary care doctor visit	In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0.00
Specialty doctor visit	Out-of-Network: Doctor Specialty Visit: Coinsurance for Medicare Covered Physician Specialist Office Visit 30%
Inpatient hospital care	In-Network: Acute Hospital Services: $275.00 per day for days 1 to 6 $0.00 per day for days 7 to 90 Prior Authorization Required for Acute Hospital Services
Urgent care	Urgent Care: Copayment for Urgent Care $65.00 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0.00
Emergency room visit	Emergency Care: Copayment for Emergency Care $90.00 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $0.00 Copayment for Worldwide Emergency Transportation $0.00
Ambulance transportation	In-Network: Ground Ambulance: Coinsurance for Ground Ambulance Services 20% Air Ambulance: Coinsurance for Air Ambulance Services 20% Section B - General 10a Note - NOTE ON AUTHORIZATION: Authorization is required for Non-emergency Medicare-covered ambulance ground and air transportation. Emergency Ambulance does not require authorization. Please see Evidence of Coverage for Prior Authorization rules

Health Care Services and Medical Supplies

UnitedHealthcare Medicare Advantage Assure (PPO) covers a range of additional benefits. Learn more about UnitedHealthcare Medicare Advantage Assure (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage	Details
Chiropractic services	Out-of-Network: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 30%
Diabetes supplies, training, nutrition therapy and monitoring	Out-of-Network: Diabetic Supplies and Services: Coinsurance for Medicare Covered Diabetic Supplies and Services 50%
Durable medical equipment (DME)	In-Network: Durable Medical Equipment: Coinsurance for Medicare-covered Durable Medical Equipment 20% Prior Authorization Required for Durable Medical Equipment
Diagnostic tests, lab and radiology services, and X-rays	Out-of-Network: Outpatient Diag Procs/Tests/Lab Services: Coinsurance for Medicare Covered Diagnostic Procedures/Tests 30% Copayment for Medicare Covered Lab Services $0.00 Coinsurance for Medicare Covered Diagnostic Radiological Services 30% Coinsurance for Medicare Covered Therapeutic Radiological Services 30% Coinsurance for Medicare Covered Outpatient X-Ray Services 30%
Home health care	In-Network: Home Health Services: Copayment for Medicare-covered Home Health Services $0.00 Prior Authorization Required for Home Health Services
Mental health inpatient care	Out-of-Network: Coinsurance for Psychiatric Hospital Services per Stay 30%
Mental health outpatient care	In-Network: Outpatient Mental Health Services: Coinsurance for Medicare-covered Individual Sessions 20% Coinsurance for Medicare-covered Group Sessions 20% Prior Authorization Required for Outpatient Mental Health Services
Outpatient services/surgery	In-Network: Outpatient Hospital Services: Coinsurance for Medicare Covered Outpatient Hospital Services 0% to 20% Prior Authorization Required for Outpatient Hospital Services Outpatient Observation Services: Coinsurance for Medicare Covered Observation Services 20% Prior Authorization Required for Outpatient Observation Services Ambulatory Surgical Center Services: Coinsurance for Ambulatory Surgical Center Services 0% to 20% Prior Authorization Required for Ambulatory Surgical Center Services
Outpatient substance abuse care	In-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare-covered Individual Sessions 20% Coinsurance for Medicare-covered Group Sessions 20% Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter items	In-Network: Over-The-Counter (OTC) Items: Copayment for Over-The-Counter (OTC) Items $0.00 Maximum Plan Benefit of $210.00 every three months Nicotine Replacement Therapy (NRT) offerred as a Part C OTC benefit
Podiatry services	In-Network: Podiatry Services: Coinsurance for Medicare-Covered Podiatry Services 20% Copayment for Routine Foot Care $0.00 Maximum 4 visits every year Prior Authorization Required for Podiatry Services
Skilled Nursing Facility (SNF) care	In-Network: Skilled Nursing Facility Services: $0.00 per day for days 1 to 20 $170.50 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Dental care	In-Network: Preventive Dental: Copayment for Oral Exams $0.00 Maximum 2 visits every year Copayment for Prophylaxis (Cleaning) $0.00 Maximum 3 visits every year Copayment for Fluoride Treatment $0.00 Maximum 2 visits every year Copayment for Dental X-Rays $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3500.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined Comprehensive Dental: Coinsurance for Medicare-covered Benefits 20% Copayment for Non-routine Services $0.00 Copayment for Diagnostic Services $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Copayment for Restorative Services $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Copayment for Endodontics $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Copayment for Periodontics $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Copayment for Extractions $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3500.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined Prior Authorization Required for Comprehensive Dental

Coverage

Details

Dental care

In-Network:

Preventive Dental:
Copayment for Oral Exams $0.00

Maximum 2 visits every year

Copayment for Prophylaxis (Cleaning) $0.00

Maximum 3 visits every year

Copayment for Fluoride Treatment $0.00

Maximum 2 visits every year

Copayment for Dental X-Rays $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Maximum Plan Benefit of $3500.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined

Comprehensive Dental:
Coinsurance for Medicare-covered Benefits 20%
Copayment for Non-routine Services $0.00
Copayment for Diagnostic Services $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Restorative Services $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Endodontics $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Periodontics $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Extractions $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Maximum Plan Benefit of $3500.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined
Prior Authorization Required for Comprehensive Dental

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Vision benefits	Out-of-Network: Medicare Covered Vision Services: Coinsurance for Medicare Covered Eye Exams 30% Coinsurance for Medicare Covered Eyewear 30% Non-Medicare Covered Vision Services: Coinsurance for Non-Medicare Covered Eye Exams 30% Copayment for Non-Medicare Covered Eyewear $0.00

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Hearing benefits	Out-of-Network: Medicare Covered Hearing Services: Coinsurance for Medicare Covered Hearing Exams 30% Non-Medicare Covered Hearing Services: Coinsurance for Non-Medicare Covered Hearing Exams 30% Copayment for Non-Medicare Covered Hearing Aids $0.00

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Preventive services and health/wellness education programs	In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vagin*l cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots: COVID-19 shots Flu shots Hepatitis B shots Pneumococcal shots Tobacco use cessation Yearly "Wellness" visit

Coverage

Details

Preventive services and health/wellness education programs

In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vagin*l cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:

COVID-19 shots

Flu shots

Hepatitis B shots

Pneumococcal shots

Tobacco use cessation
Yearly "Wellness" visit

Prescription Drug Costs and Coverage

The UnitedHealthcare Medicare Advantage Assure (PPO) offers prescription drug coverage, with an annual drug deductible of $480.00 (excludes Tier 1)

Coverage	Cost
Coverage & Cost
Annual drug deductible	$480.00 (excludes Tier 1)
Tier 1	Preferred retail 25% Standard retail 25% Preferred mail order 25% Standard mail order 25%
Annual drug deductible	$480.00 (excludes Tier 1)
Tier 1	Preferred retail N/A Standard retail N/A Preferred mail order N/A Standard mail order N/A
Annual drug deductible	$480.00 (excludes Tier 1)
Tier 1	Preferred retail 25% Standard retail 25% Preferred mail order 25% Standard mail order 25%

When reviewing Illinois Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

You may be able to find plans in your part of Illinois that offer similar benefits at similar or lower prices than the plan above. Call 1-855-580-1854 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

Plan Documents

Links to plan documents

Summary of benefits
Star ratings

Illinois Counties Served

Boone Bureau Carroll Cook Dekalb Dupage Henderson Henry Jo Daviess Kane Kankakee Kendall Knox Lake Lee Marshall Mchenry Mclean Mercer Ogle Peoria Putnam Rock Island Sangamon Stark Stephenson Tazewell Warren Whiteside Will Winnebago Woodford

We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

Back to plans in Illinois

UnitedHealthcare Medicare Advantage Assure (PPO) H0271-004-000 2022 Plan Details and Costs (2024)

FAQs

How much should I expect to pay for a Medicare Advantage plan? ›

The estimated average monthly Medicare Advantage plan premium for 2024 is $18.50, but this cost may vary based on the insurer and level of coverage. Some plan premiums could be $0, while others could be $200 or more. To join a Medicare Advantage plan, you must also be enrolled in Medicare Parts A and B.

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What is the difference between Medicare and Medicare Advantage PPO? ›

Medicare Advantage is an alternative to traditional Medicare offered by private health insurance companies. Medicare Advantage plans cover all the same services under Original Medicare Part A and Part B, but often include prescription drug coverage and extra benefits.

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What is the difference between Medicare and UHC Medicare Advantage? ›

Original Medicare covers inpatient hospital and skilled nursing services – Part A - and doctor visits, outpatient services and some preventative care – Part B. Medicare Advantage plans cover all the above (Part A and Part B), and most plans also cover prescription drugs (Part D).

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What do Medicare Advantage plans usually cover? ›

With a Medicare Advantage Plan, you may have coverage for things Original Medicare doesn't cover, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services (like routine checkups or cleanings).

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Does everyone pay $170 for Medicare? ›

If you don't get premium-free Part A, you pay up to $505 each month. If you don't buy Part A when you're first eligible for Medicare (usually when you turn 65), you might pay a penalty. Most people pay the standard Part B monthly premium amount ($174.70 in 2024).

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Why are people leaving Medicare Advantage plans? ›

Most individuals that dislike a Medicare Advantage plan usually have had a bad experience with in-network providers, plan authorizations for medical care, or having to wait a long time to have an appointment scheduled. Some of these concerns can be attributed to the healthcare provider.

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What is the most highly rated Medicare Advantage plan? ›

Our Top Medicare Advantage Providers

Best Consumer Reputation: Blue Cross Blue Shield.
Best Nationwide Coverage: Humana.
Best Local Support Services: Aetna.
Largest Provider Network: UnitedHealthcare.
Best Additional Benefits: Cigna.
Best Overall CMS Rating: Anthem.

Jun 3, 2024

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What is the best supplemental insurance for Medicare? ›

Here's an overview of our top picks:

Best for Medigap plan options: AARP/UnitedHealthcare Medicare Supplement Insurance.
Best for member satisfaction: State Farm Medicare Supplement Insurance.
Best for premium discounts: Mutual of Omaha Medicare Supplement Insurance.

More items...

May 21, 2024

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What is the disadvantage of UnitedHealthcare? ›

Special needs plans can get pricey: While lower-priced plans are available, UnitedHealthcare also offers the highest-priced special needs plan (SNP) in 2024, so it's worth keeping an eye on the cost for plans that fit your needs.

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Why do doctors not like Medicare Advantage plans? ›

Doctor Challenges

While many physicians work within the Medicare Advantage networks with few problems, the plans do not come without issues. One of the primary challenges doctors face is referral and pre-authorization requirements that may impede a patient's needed medical care.

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Which is better, a supplement or advantage plan? ›

A Medicare Advantage plan may be a better choice if it has an out-of-pocket maximum that protects you from huge bills. Regular Medicare plus a Medigap insurance plan generally allows you more choice in where you receive your care.

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What is the true cost of Medicare Advantage plans? ›

Average Costs of Medicare Advantage Plans by Insurance Company
Medicare Advantage Company	Average Medicare Star Ratings	Average Monthly Premium
AARP/UnitedHealthcare	3.94	$17.37
Aetna/CVS	3.65	$16.73
Blue Cross Blue Shield	4.01	$53.42

4 more rows

Dec 12, 2023

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Does Medicare cover 100% of hospital bills? ›

No. Even though Medicare can cover many of your health care costs, you'll still have some out-of-pocket expenses, including premiums, deductibles, copayments and coinsurance.

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Do I still pay Medicare premiums with an Advantage plan? ›

Medicare Advantage Plan (Part C):

You must keep paying your Part B premium to stay in your plan. Deductibles, coinsurance, and copayments vary based on which plan you join. Plans also have a yearly limit on what you pay out-of-pocket.

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What is the average cost of Medicare Advantage plans in 2024? ›

While the average cost of Medicare Advantage is projected to be $18.50 per month in 2024, the amount you end up paying can vary.

Learn More Now ›

What is the average maximum out-of-pocket cost for a Medicare Advantage plan? ›

The average out-of-pocket limit for Medicare Advantage enrollees is $4,835 for in-network services and $8,659 for both in-network and out-of-network services (PPOs). Since 2011, federal regulation has required Medicare Advantage plans to provide an out-of-pocket limit for services covered under Parts A and B.

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Are Medicare Advantage plans cheaper than original Medicare? ›

In a nutshell, most Medicare Advantage plans provide similar coverage to Original Medicare with a Part D prescription drug plan and a Medicare supplement plan. Premiums and overall costs tend to be lower with Medicare Advantage, especially if you expect to have high costs for care.

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What is cheaper Medicare Supplement or Medicare Advantage? ›

Your premiums may be lower: Medicare Advantage plans generally offer low monthly premiums (in addition to your Part B premium) or no-premium plans. This may cost you less per month than having Original Medicare, Part D, and a Medigap policy.