United Healthcare Physical Therapy Copay



All UnitedHealthcare Medicare Advantage plans have an annual out-of-pocket maximum for covered medical benefits. Copays and coinsurance may vary depending on the member's plan. Group Retiree plans may have different copays and coinsurance. To help member’s get the care they need, we are waiving cost-share (copays, coinsurance and deductibles) for our Medicare Advantage plan members as follows. Members will have a $0 copay for primary care provider (PCP) and specialist physician services, as well as other covered services (listed below) between May 11, 2020 until at least. UMR is a UnitedHealthcare company. ©2021 United HealthCare Services, Inc. Careers - Opens in a new window. Your privacy is important to us! At UMR, we are very sensitive to privacy issues. To better understand the procedures and protocols we follow to help to ensure your privacy, please review the following information.

2021 Medicare Advantage Plan Details
Medicare Plan Name:UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)
Location:Schuyler, New York
Plan ID:R5342 - 001 - 0 Click to see other plans
Member Services:1-800-711-6088 TTY users 711
— Enrollment Options —
Medicare Contact Information:1-800-MEDICARE (1-800-633-4227)
TTY users 1-877-486-2048
Medicare plan advice at no cost from licensed insurance agents. Call: 888-205-9813 / TTY 711
Monday‐Friday 8am — 8pm ET

Email a copy of the UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO) benefit details
— Medicare Plan Features —
Monthly Premium:$16.00 (see Plan Premium Details below)
Annual Deductible:$300 (Tier Yes excluded from the Deductible.)
Annual Initial Coverage Limit (ICL):$4,130
Health Plan Type:Regional PPO
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$6,700
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:3,609 drugsBrowse the UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO) Formulary
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers.
This plan offers select insulin at $35 or less. Learn more.
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
Preferred Pharmacy
Cost-Sharing during
initial coverage phase:
$3.00$12.00$47.00$100.0027%
Number of Drugs per
Tier:
3036758671010754
Plan's Pharmacy Search:http://www.UHCMedicareSolutions.com
Plan Offers Mail Order?Yes
Number of Members enrolled in this plan in Schuyler, New York:185 members
Number of Members enrolled in this plan in (R5342 - 001):92,636 members
Plan’s Summary Star Rating:4 out of 5 Stars.
Customer Service Rating:5 out of 5 Stars.
Member Experience Rating:3 out of 5 Stars.
Drug Cost Accuracy Rating:4 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows:
Total
Premium
Part C
Premium
Part D Base
Premium
Part D Supplemental
Premium
$16.00$0.00$16.00$0.00
Monthly Premium with Extra Help Low-Income Subsidy (LIS):100%
Subsidy
75%
Subsidy
50%
Subsidy
25%
Subsidy
Monthly Part D Premium with LIS:$0.00$4.00$8.00$12.00
Total Monthly Premium with LIS (Parts C & D):$0.00$4.00$8.00$12.00
— Plan Health Benefits —
** Base Plan **
Premium
• Health plan premium: $0
• Drug plan premium: $16
• You must continue to pay your Part B premium.
• Part B premium reduction: No
Deductible
• Health plan deductible: $0
• Other health plan deductibles: In-network: No
• Drug plan deductible: $300.00 annual deductible
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
• $10,000 In and Out-of-network
$6,700 In-network
Optional supplemental benefits
• Yes
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
• In-network: No
Doctor visits
• Primary In-network: $0 copay
• Primary Out-of-network: $50 copay per visit
• Specialist In-network: $45 copay per visit (authorization required)
• Specialist Out-of-network: $75 copay per visit (authorization required)
Diagnostic procedures/lab services/imaging
• Diagnostic tests and procedures In-network: $30 copay (authorization required)
• Diagnostic tests and procedures Out-of-network: 40% coinsurance (authorization required)
• Lab services In-network: $0 copay (authorization required)
• Lab services Out-of-network: $0 copay (authorization required)
• Diagnostic radiology services (e.g., MRI) In-network: $0-160 copay (authorization required)
• Diagnostic radiology services (e.g., MRI) Out-of-network: 40% coinsurance (authorization required)
• Outpatient x-rays In-network: $50 copay (authorization required)
• Outpatient x-rays Out-of-network: $50 copay (authorization required)
Emergency care/Urgent care
• Emergency: $90 copay per visit (always covered)
• Urgent care: $30-40 copay per visit (always covered)
Inpatient hospital coverage
• In-network: $375 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond (authorization required)
• Out-of-network: $500 per day for days 1 through 20
$0 per day for days 21 and beyond (authorization required)
Outpatient hospital coverage
• In-network: $0-325 copay per visit (authorization required)
• Out-of-network: 40% coinsurance per visit (authorization required)
Skilled Nursing Facility
• In-network: $0 per day for days 1 through 20
$184 per day for days 21 through 57
$0 per day for days 58 through 100 (authorization required)
• Out-of-network: $225 per day for days 1 through 45
$0 per day for days 46 through 100 (authorization required)
Preventive care
• In-network: $0 copay
• Out-of-network: 0-40% coinsurance
Ground ambulance
• In-network: $250 copay
• Out-of-network: $250 copay
Rehabilitation services
• Occupational therapy visit In-network: $40 copay (authorization required)
• Occupational therapy visit Out-of-network: $75 copay (authorization required)
• Physical therapy and speech and language therapy visit In-network: $40 copay (authorization required)
• Physical therapy and speech and language therapy visit Out-of-network: $75 copay (authorization required)
Mental health services
• Inpatient hospital - psychiatric In-network: $375 per day for days 1 through 4
$0 per day for days 5 through 90 (authorization required)
• Inpatient hospital - psychiatric Out-of-network: $500 per day for days 1 through 20
$0 per day for days 21 through 90 (authorization required)
• Outpatient group therapy visit with a psychiatrist In-network: $15 copay (authorization required)
• Outpatient group therapy visit with a psychiatrist Out-of-network: $30-40 copay (authorization required)
• Outpatient individual therapy visit with a psychiatrist In-network: $25 copay (authorization required)
• Outpatient individual therapy visit with a psychiatrist Out-of-network: $30-40 copay (authorization required)
• Outpatient group therapy visit In-network: $15 copay (authorization required)
• Outpatient group therapy visit Out-of-network: $30-40 copay (authorization required)
• Outpatient individual therapy visit In-network: $25 copay (authorization required)
• Outpatient individual therapy visit Out-of-network: $30-40 copay (authorization required)
Medical equipment/supplies
• Durable medical equipment (e.g., wheelchairs, oxygen) In-network: 20% coinsurance per item (authorization required)
• Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-network: 50% coinsurance per item (authorization required)
• Prosthetics (e.g., braces, artificial limbs) In-network: 20% coinsurance per item (authorization required)
• Prosthetics (e.g., braces, artificial limbs) Out-of-network: 40% coinsurance per item (authorization required)
• Diabetes supplies In-network: $0 copay per item (authorization required)
• Diabetes supplies Out-of-network: 40% coinsurance per item (authorization required)
Hearing
• Hearing exam In-network: $0 copay (authorization required)
• Hearing exam Out-of-network: $75 copay (authorization required)
• Fitting/evaluation: Not covered
• Hearing aids In-network: $375-2,075 copay (limits apply, authorization required)
• Hearing aids Out-of-network: $375 copay (limits apply, authorization required)
Preventive dental
• Oral exam In-network: $0 copay (limits apply)
• Oral exam Out-of-network: $0 copay (limits apply)
• Cleaning In-network: $0 copay (limits apply)
• Cleaning Out-of-network: $0 copay (limits apply)
• Fluoride treatment In-network: $0 copay (limits apply)
• Fluoride treatment Out-of-network: $0 copay (limits apply)
• Dental x-ray(s) In-network: $0 copay (limits apply)
• Dental x-ray(s) Out-of-network: $0 copay (limits apply)
Comprehensive dental
• Non-routine services: Not covered
• Diagnostic services: Not covered
• Restorative services: Not covered
• Endodontics: Not covered
• Periodontics: Not covered
• Extractions: Not covered
• Prosthodontics, other oral/maxillofacial surgery, other services: Not covered
Vision
• Routine eye exam In-network: $0 copay (limits apply, authorization required)
• Routine eye exam Out-of-network: $75 copay (limits apply, authorization required)
• Other: Not covered
• Contact lenses In-network: $0 copay (limits apply)
• Contact lenses Out-of-network: $0 copay (limits apply)
• Eyeglasses (frames and lenses) In-network: $0 copay (limits apply)
• Eyeglasses (frames and lenses) Out-of-network: $0 copay (limits apply)
• Eyeglass frames: Not covered
• Eyeglass lenses: Not covered
• Upgrades: Not covered
Wellness programs (e.g., fitness, nursing hotline)
• Covered
Transportation
Not covered
Foot care (podiatry services)
• Foot exams and treatment In-network: $45 copay (authorization required)
• Foot exams and treatment Out-of-network: $75 copay (authorization required)
• Routine foot care In-network: $45 copay (limits apply, authorization required)
• Routine foot care Out-of-network: $75 copay (limits apply, authorization required)
Medicare Part B drugs
• Chemotherapy In-network: 20% coinsurance (authorization required)
• Chemotherapy Out-of-network: 40% coinsurance (authorization required)
• Other Part B drugs In-network: 20% coinsurance (authorization required)
• Other Part B drugs Out-of-network: 40% coinsurance (authorization required)
Package #1
• Monthly Premium: $40.00
• Deductible:

Jump to:

AARP Medicare Advantage Choice (PPO) H2406-018 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by UnitedHealthcare available to residents in Florida. This plan includes additional Medicare prescription drug (Part-D) coverage. The AARP Medicare Advantage Choice (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,400 out of pocket. This can be a extremely nice safety net.

AARP Medicare Advantage Choice (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

UnitedHealthcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for AARP Medicare Advantage Choice (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from UnitedHealthcare and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from UnitedHealthcare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



Ready to Enroll?


Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST



2021 UnitedHealthcare Medicare Advantage Plan Costs

Name:
Plan ID:
H2406-018
Provider:UnitedHealthcare
Year:2021
Type: Local PPO
Monthly Premium C+D: $0
Part C Premium: $0
MOOP: $3,400
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
Drug Deductible: $150.0
Tiers with No Deductible:1
Gap Coverage:No
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan:H2406-019

AARP Medicare Advantage Choice (PPO) Part-C Premium

UnitedHealthcare plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


H2406-018 Part-D Deductible and Premium

AARP Medicare Advantage Choice (PPO) has a monthly drug premium of $0 and a $150.0 drug deductible. Sky go free for sky customers login. This UnitedHealthcare plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by UnitedHealthcare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.


UnitedHealthcare Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This UnitedHealthcare plan does not offer additional coverage through the gap.


H2406-018 Formulary or Drug Coverage

AARP Medicare Advantage Choice (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.



United healthcare physical therapy coverage

2021 AARP Medicare Advantage Choice (PPO) Summary of Benefits



Additional Benefits


No


Comprehensive Dental


Diagnostic services0-50% coinsurance (Out-of-Network)
Diagnostic services$0 copay
Endodontics0-50% coinsurance (Out-of-Network)
Endodontics$0 copay
Extractions50% coinsurance
Extractions0-50% coinsurance (Out-of-Network)
Non-routine services0-50% coinsurance (Out-of-Network)
Non-routine services50% coinsurance
Periodontics0-50% coinsurance (Out-of-Network)
Periodontics50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services0-50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services0-50% coinsurance (Out-of-Network)
Restorative services0-50% coinsurance
Restorative services0-50% coinsurance (Out-of-Network)


Deductible


$0


Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI)$0-110 copay
Diagnostic radiology services (e.g., MRI)40% coinsurance (Out-of-Network)
Diagnostic tests and procedures$20 copay
Diagnostic tests and procedures40% coinsurance (Out-of-Network)
Lab services$0 copay (Out-of-Network)
Lab services$0 copay
Outpatient x-rays$20 copay (Out-of-Network)
Outpatient x-rays$15 copay


Doctor Visits


Therapy
Primary$0 copay
Primary$45 copay per visit (Out-of-Network)
Specialist$70 copay per visit (Out-of-Network)
Specialist$35 copay per visit


Emergency care/Urgent Care


Emergency$90 copay per visit (always covered)
Urgent care$30-40 copay per visit (always covered)


Foot Care (podiatry services)


Foot exams and treatment$35 copay
Foot exams and treatment$70 copay (Out-of-Network)
Routine foot care$35 copay
Routine foot care$70 copay (Out-of-Network)


Ground Ambulance


$250 copay (Out-of-Network)
$250 copay


Hearing


Fitting/evaluationNot covered
Hearing aids$375-2,075 copay
Hearing aids$375 copay (Out-of-Network)
Hearing exam$0 copay
Hearing exam$70 copay (Out-of-Network)


Inpatient Hospital Coverage


$280 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
40% per stay (Out-of-Network)


Medical Equipment/Supplies


Diabetes supplies$0 copay per item
Diabetes supplies40% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)50% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)40% coinsurance per item (Out-of-Network)


Medicare Part B Drugs


Chemotherapy50% coinsurance (Out-of-Network)
Chemotherapy20% coinsurance
Other Part B drugs50% coinsurance (Out-of-Network)
Other Part B drugs20% coinsurance


Mental Health Services


Inpatient hospital - psychiatric40% per stay (Out-of-Network)
Inpatient hospital - psychiatric$280 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient group therapy visit$30-40 copay (Out-of-Network)
Outpatient group therapy visit$15 copay
Outpatient group therapy visit with a psychiatrist$15 copay
Outpatient group therapy visit with a psychiatrist$30-40 copay (Out-of-Network)
Outpatient individual therapy visit$25 copay
Outpatient individual therapy visit$30-40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist$30-40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist$25 copay


MOOP


$5,100 In and Out-of-network
$3,400 In-network


Option


No


Optional supplemental benefits


No

United Healthcare Physical Therapy Copay

Outpatient Hospital Coverage


$0-275 copay per visit
40% coinsurance per visit (Out-of-Network)


Preventive Care


0-40% coinsurance (Out-of-Network)
$0 copay


Preventive Dental


Cleaning$0 copay
Cleaning$0 copay (Out-of-Network)
Dental x-ray(s)$0 copay
Dental x-ray(s)$0 copay (Out-of-Network)
Fluoride treatment$0 copay (Out-of-Network)
Fluoride treatment$0 copay
Oral exam$0 copay
Oral exam$0 copay (Out-of-Network)

United Healthcare Physical Therapy Copay

Rehabilitation Services


Occupational therapy visit$70 copay (Out-of-Network)
Occupational therapy visit$35 copay
Physical therapy and speech and language therapy visit$70 copay (Out-of-Network)
Physical therapy and speech and language therapy visit$35 copay


Skilled Nursing Facility


$225 per day for days 1 through 23
$0 per day for days 24 through 100 (Out-of-Network)
$0 per day for days 1 through 20
$184 per day for days 21 through 39
$0 per day for days 40 through 100


Transportation


Not covered


Vision


Contact lenses$0 copay (Out-of-Network)
Contact lenses$0 copay
Eyeglass framesNot covered
Eyeglass lensesNot covered
Eyeglasses (frames and lenses)$0 copay
Eyeglasses (frames and lenses)$0 copay (Out-of-Network)
OtherNot covered
Routine eye exam$0 copay
Routine eye exam$70 copay (Out-of-Network)
UpgradesNot covered

United Healthcare Medicare Physical Therapy



Wellness Programs (e.g. fitness nursing hotline)

Is Physical Therapy Covered By United Healthcare


Covered

Reviews for AARP Medicare Advantage Choice (PPO) H2406


2019 Overall Rating
Part C Summary Rating
Part D Summary 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

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in AARP Medicare Advantage Choice (PPO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for AARP Medicare Advantage Choice (PPO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

AARP Medicare Advantage Choice (PPO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Ready to Enroll?


Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST



Coverage Area for AARP Medicare Advantage Choice (PPO)

(Click county to compare all available Advantage plans)

State: Florida
County:Broward,Miami Dade,Palm Beach,

Go to top

Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.