q1medicare.com
Powered by Q1Group LLC
A non-government resource for the Medicare community
Powered by Q1Group LLC
A non-government Medicare community resource
  • Menu ☰
  • Home
  • Contact
  • MAPD
  • PDP
  • 2024
  • 2025
  • FAQs
  • Articles
  • Search ⌕
  • Contact
  • 2024
  • 2025
  • FAQs
  • Articles
  • Latest Medicare News
  • Search ⌕

This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2013 UnitedHealthcare Dual Complete RP (Regional PPO SNP) in Statewide, Florida 33142

Medicare Advantage Plan Benefit Details in Plain Text
The following Medicare Advantage plan benefits apply to the UnitedHealthcare Dual Complete RP (Regional PPO SNP) (R5287 - 003) in Statewide, Florida 33142.

This plan is administered by .  To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the UnitedHealthcare Dual Complete RP (Regional PPO SNP) health and prescription benefit details in chart format or email and view benefits chart

Plan Premium
The UnitedHealthcare Dual Complete RP (Regional PPO SNP) has a monthly premium of $24.80. That is $297.60 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher. Please remember that the $24.80 montly premium is in addition to your Medicare Part B premium. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).

This Medicare Advantage Plan with Prescription Drug Coverage is a Regional PPO plan.

Plan Membership and Plan Ratings
The UnitedHealthcare Dual Complete RP (Regional PPO SNP) (R5287 - 003) currently has 15,936 members.

The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 3 stars. The detail CMS plan carrier ratings are as follows:
  • Customer Service Rating of 4 out of 5 stars
  • Member Experience Rating of 3 out of 5 stars
  • Drug Cost Information Accuracy Rating of 3 out of 5 stars
Prescription Drug Coverage: Deductible, Cost-sharing, Formulary
This plan has a $325 deductible. So, you are 100% responsible for the first $325 in medication costs. After you have met the deductible, the UnitedHealthcare Dual Complete RP (Regional PPO SNP) will share the costs of your medications with you -- see cost-sharing below. $325 is the maximum deductible for 2013. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Click here to review plans with a $0 deductible.

The following information is about the UnitedHealthcare Dual Complete RP (Regional PPO SNP) formulary (or drug list). There are 3620 drugs on the UnitedHealthcare Dual Complete RP (Regional PPO SNP) formulary. Click here to browse the UnitedHealthcare Dual Complete RP (Regional PPO SNP) Formulary.
 
The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $325, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The UnitedHealthcare Dual Complete RP (Regional PPO SNP)’s formulary is divided into 5 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows:
  • Tier 1 (Tier 1) contains 0 drugs and has a co-insurance of 25% of the drug cost.
  • Tier 2 (Tier 2) contains 0 drugs and has a co-insurance of 25% of the drug cost.
  • Tier 3 (Tier 3) contains 0 drugs and has a co-insurance of 25% of the drug cost.
  • Tier 4 (Tier 4) contains 0 drugs and has a co-insurance of 25% of the drug cost.
  • Tier 5 (Tier 5) contains 0 drugs and has a co-insurance of 25% of the drug cost.
    •  
Click here to browse the UnitedHealthcare Dual Complete RP (Regional PPO SNP) Formulary.

The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 21% of your generic drug prescription costs in the donut hole on your behalf.

The brand-name drug manufacturer will pay 50% and your plan will pay an additional 2.5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 52.5% discount. The 50% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (UnitedHealthcare Dual Complete RP (Regional PPO SNP))offers Coverage for during the Coverage Gap phase.

The UnitedHealthcare Dual Complete RP (Regional PPO SNP) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail.

** Cost **
Premium and Other Important Information
* Depending on your level of Medicaid eligibility you may not have any cost-sharing responsibility for original Medicare services
** Please consult with your plan about cost sharing when receiving services from out-of-network providers.
$24.8 monthly plan premium in addition to your monthly Medicare Part B premium.*
Some physicians providers and suppliers that are out of a plan’s network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept Medicare "assignment " your coinsurance can be based on the Medicare-approved amount plus an additional amount up to a higher Medicare "limiting charge." If you are a member of a plan that charges a copay for out-of-network physician services the higher Medicare "limiting charge" does not apply. See the publications Medicare You or Your Medicare Benefits available on www.medicare.gov for a full listing of benefits under Original Medicare as well as for explanations of the rules related to "assignment" and "limiting charges" that apply by benefit type. To find out if physicians and DME suppliers accept assignment or participate in Medicare visit www.medicare.go
$6 700 out-of-pocket limit for Medicare-covered services.*
$10 000 out-of-pocket limit for Medicare-covered services.*
** Doctor and Hospital Choice **
Doctor and Hospital Choice
No referral required for network doctors specialists and hospitals.
You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits.
** Extra Benefits **
Over-the-Counter Items
Please visit our plan website to see our list of covered Over-the-Counter items. OTC items may be purchased only for the enrollee. Please contact the plan for specific instructions for using this benefit.
Transportation
$0 copay for up to 24 one-way trip(s) to plan approved location every year
75% of the cost for transportation.
** Important Information **
Premium and Other Important Information
* Depending on your level of Medicaid eligibility you may not have any cost-sharing responsibility for original Medicare services
** Please consult with your plan about cost sharing when receiving services from out-of-network providers.
$24.8 monthly plan premium in addition to your monthly Medicare Part B premium.*
Some physicians providers and suppliers that are out of a plan’s network (i.e. out-of-network) accept "assignment" from Medicare and will only charge up to a Medicare-approved amount. If you choose to see an out-of-network physician who does NOT accept Medicare "assignment " your coinsurance can be based on the Medicare-approved amount plus an additional amount up to a higher Medicare "limiting charge." If you are a member of a plan that charges a copay for out-of-network physician services the higher Medicare "limiting charge" does not apply. See the publications Medicare You or Your Medicare Benefits available on www.medicare.gov for a full listing of benefits under Original Medicare as well as for explanations of the rules related to "assignment" and "limiting charges" that apply by benefit type. To find out if physicians and DME suppliers accept assignment or participate in Medicare visit www.medicare.go
$6 700 out-of-pocket limit for Medicare-covered services.*
$10 000 out-of-pocket limit for Medicare-covered services.*
Doctor and Hospital Choice
No referral required for network doctors specialists and hospitals.
You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits.
** Inpatient Care **
Inpatient Hospital Care
No limit to the number of days covered by the plan each hospital stay.
$0 or $1 188 copay for each Medicare-covered hospital stay*
$0 copay for each additional hospital day.
30% of the cost for each hospital stay.**
Inpatient Mental Health Care
You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.
$0 or $1 188 copay for each Medicare-covered hospital stay*
30% of the cost for each hospital stay.**
Skilled Nursing Facility (SNF)
Plan covers up to 100 days each benefit period
No prior hospital stay is required.
You will not be charged additional cost sharing for professional services
30% of the cost for each SNF stay.**
Home Health Care
$0 copay for each Medicare-covered home health visit*
30% of the cost for Medicare-covered home health visits**
Hospice
You must get care from a Medicare-certified hospice. Your plan will pay for a consultative visit before you select hospice.
** Outpatient Care **
Doctor Office Visits
$0 copay for each Medicare-covered primary care doctor visit.*
0% or 20% of the cost for each Medicare-covered specialist visit.*
30% of the cost for each Medicare-covered primary care doctor visit**
30% of the cost for each Medicare-covered specialist visit**
Chiropractic Services
0% or 20% of the cost for each Medicare-covered chiropractic visit*
Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor.
30% of the cost for Medicare-covered chiropractic visits.**
Podiatry Services
0% or 20% of the cost for each Medicare-covered podiatry visit*
$0 copay for up to 4 supplemental routine podiatry visit(s) every year
Medicare-covered podiatry visits are for medically-necessary foot care.
30% of the cost for Medicare-covered podiatry visits**
30% of the cost for supplemental routine podiatry visits**
Outpatient Mental Health Care
0% or 20% of the cost for each Medicare-covered individual therapy visit*
0% or 20% of the cost for each Medicare-covered group therapy visit*
0% or 20% of the cost for each Medicare-covered individual therapy visit with a psychiatrist*
0% or 20% of the cost for each Medicare-covered group therapy visit with a psychiatrist*
0% or 20% of the cost for Medicare-covered partial hospitalization program services*
30% of the cost for Medicare-covered Mental Health visits with a psychiatrist**
30% of the cost for Medicare-covered Mental Health visits**
30% of the cost for Medicare-covered partial hospitalization program services**
Outpatient Substance Abuse Care
0% or 20% of the cost for Medicare-covered individual substance abuse outpatient treatment visits*
0% or 20% of the cost for Medicare-covered group substance abuse outpatient treatment visits*
30% of the cost Medicare-covered substance abuse outpatient treatment visits**
Outpatient Services
0% or 20% of the cost for each Medicare-covered ambulatory surgical center visit*
0% or 20% of the cost for each Medicare-covered outpatient hospital facility visit*
30% of the cost for Medicare-covered outpatient hospital facility visits**
30% of the cost for Medicare-covered ambulatory surgical center visits**
Ambulance Services
0% or 20% of the cost for Medicare-covered ambulance benefits.*
30% of the cost for Medicare-covered ambulance benefits.**
Emergency Care
$0 or $65 copay for Medicare-covered emergency room visits*
Worldwide coverage.
If you are admitted to the hospital within 24-hour(s) for the same condition you pay $0 for the emergency room visit.
Urgently Needed Care
0% or 20% of the cost for Medicare-covered urgently-needed-care visits*
Outpatient Rehabilitation Services
0% or 20% of the cost for Medicare-covered Occupational Therapy visits*
0% or 20% of the cost for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits*
30% of the cost for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits**
30% of the cost for Medicare-covered Occupational Therapy visits.**
** Outpatient Medical Services and Supplies **
Durable Medical Equipment
0% or 20% of the cost for Medicare-covered durable medical equipment*
30% of the cost for Medicare-covered durable medical equipment**
Prosthetic Devices
0% or 20% of the cost for Medicare-covered prosthetic devices*
30% of the cost for Medicare-covered prosthetic devices.**
Diabetes Programs and Supplies
$0 copay for Medicare-covered Diabetes self-management training*
$0 copay for Medicare-covered Diabetes monitoring supplies*
0% or 20% of the cost for Medicare-covered Therapeutic shoes or inserts*
30% of the cost for Medicare-covered Diabetes self-management training**
30% of the cost for Medicare-covered Diabetes monitoring supplies**
30% of the cost for Medicare-covered Therapeutic shoes or inserts**
Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
$0 copay for Medicare-covered lab services*
0% or 20% of the cost for Medicare-covered diagnostic procedures and tests*
0% or 20% of the cost for Medicare-covered X-rays*
0% or 20% of the cost for Medicare-covered diagnostic radiology services (not including X-rays)*
0% or 20% of the cost for Medicare-covered therapeutic radiology services*
30% of the cost for Medicare-covered therapeutic radiology services**
30% of the cost for Medicare-covered outpatient X-rays**
30% of the cost for Medicare-covered diagnostic radiology services**
0% to 30% of the cost for Medicare-covered diagnostic procedures tests and lab services**
** Preventive Services **
Cardiac and Pulmonary Rehabilitation Services
0% or 20% of the cost for Medicare-covered Cardiac Rehabilitation Services*
0% or 20% of the cost for Medicare-covered Intensive Cardiac Rehabilitation Services*
0% or 20% of the cost for Medicare-covered Pulmonary Rehabilitation Services*
30% of the cost for Medicare-covered Cardiac Rehabilitation Services**
30% of the cost for Medicare-covered Intensive Cardiac Rehabilitation Services**
30% of the cost for Medicare-covered Pulmonary Rehabilitation Services**
Preventive Services and Wellness/Education Programs
$0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.
This plan does not cover supplemental education/wellness programs.
0% to 30% of the cost for Medicare-covered preventive services**
Kidney Disease and Conditions
0% or 20% of the cost for Medicare-covered renal dialysis*
$0 copay for Medicare-covered kidney disease education services*
30% of the cost for Medicare-covered kidney disease education services**
20% of the cost for Medicare-covered renal dialysis**
Outpatient Prescription Drugs
$0 yearly deductible for Medicare Part B drugs.*
0% or 20% of the cost for Medicare Part B chemotherapy drugs and other Part B drugs.*
30% of the cost for Medicare Part B drugs out-of-network.**
This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at www.UHCMedicareSolutions.com on the web.
Different out-of-pocket costs may apply for people who
  • have limited incomes
  • live in long term care facilities or
  • have access to Indian/Tribal/Urban (Indian Health Service) providers.
The plan offers national in-network prescription coverage (i.e. this would include 50 states and the District of Columbia). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan’s service area (for instance when you travel).
Total yearly drug costs are the total drug costs paid by you the plan and Medicare.
The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition.
Your provider must get prior authorization from UnitedHealthcare Dual Complete RP (Regional PPO SNP) for certain drugs.
You must go to certain pharmacies for a very limited number of drugs due to special handling provider coordination or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan’s website formulary printed materials as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov.
If the actual cost of a drug is less than the normal cost-sharing amount for that drug you will pay the actual cost not the higher cost-sharing amount.
You pay a $0 annual deductible.
Depending on your income and institutional status you pay the following: For generic drugs (including brand drugs treated as generic) either:
  • A $0 copay or
  • A $1.15 copay or
  • A $2.65 copay
For all other drugs either:
  • A $0 copay or
  • A $3.50 copay or
  • A $6.60 copay.
You can get drugs the following way(s):
  • one-month (31-day) supply
  • three-month (90-day) supply
    • You can get drugs the following way(s):
    • one-month (31-day) supply of generic drugs
  • 31-day supply of brand drugs.
    • Please note that brand drugs must be dispensed incrementally in long-term care facilities. Generic drugs may be dispensed incrementally. Contact your plan about cost-sharing billing/collection when less than a one-month supply is dispensed.
    You can get drugs the following way(s):
    • three-month (90-day) supply
    After your yearly out-of-pocket drug costs reach $4 750 you pay a $0 copay.
    Plan drugs may be covered in special circumstances for instance illness while traveling outside of the plan’s service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition you will likely have to pay the pharmacy’s full charge for the drug and submit documentation to receive reimbursement from UnitedHealthcare Dual Complete RP (Regional PPO SNP).
    You can get out-of-network drugs the following way:
    • one-month (31-day) supply
    Depending on your income and institutional status you will be reimbursed by UnitedHealthcare Dual Complete RP (Regional PPO SNP) up to the plan’s cost of the drug minus the following: For generic drugs purchased out-of-network (including brand drugs treated as generic) either:
  • A $0 copay or
  • A $1.15 copay or
  • A $2.65 copay
    • For all other drugs purchased out-of-network either:
    • A $0 copay or
    • A $3.50 copay or
    • A $6.60 copay.
    After your yearly out-of-pocket drug costs reach $4 750 you will be reimbursed in full for drugs purchased out-of-network.
    Dental Services
    0% or 20% of the cost for Medicare-covered dental benefits*
    • $0 copay for up to 1 oral exam(s) every six months
  • $0 copay for up to 1 cleaning(s) every six months
  • $0 copay for up to 1 dental x-ray(s)
    • 30% of the cost for Medicare-covered comprehensive dental benefits**
    $40 copay for supplemental preventive dental benefits
    Hearing Services
    In general supplemental routine hearing exams and hearing aids not covered.
    0% or 20% of the cost for Medicare-covered diagnostic hearing exams*
    30% of the cost for Medicare-covered diagnostic hearing exams.**
    ** Additional Benefits **
    Vision Services
    • $0 copay for one pair of Medicare-covered eyeglasses or contact lenses after cataract surgery*
  • 0% or 20% of the cost for Medicare-covered exams to diagnose and treat diseases and conditions of the eye.*
  • $0 copay for up to 1 supplemental routine eye exam(s) every two years
  • $0 copay for contacts
  • $0 copay for up to 1 pair(s) of lenses every two years
  • $0 copay for up to 1 frame(s) every two years
    • 30% of the cost for Medicare-covered eye exams**
    30% of the cost for supplemental eye exams**
    $0 copay for Medicare-covered eye wear**
    $0 copay for supplemental eye wear**
    $100 plan coverage limit for eye wear every two years. This limit applies to both in-network and out-of-network benefits.
    Over-the-Counter Items
    Please visit our plan website to see our list of covered Over-the-Counter items. OTC items may be purchased only for the enrollee. Please contact the plan for specific instructions for using this benefit.
    Transportation
    $0 copay for up to 24 one-way trip(s) to plan approved location every year
    75% of the cost for transportation.
    Acupuncture
    This plan does not cover Acupuncture.
    ** Inpatient Care **
    Inpatient Hospital Care
    No limit to the number of days covered by the plan each hospital stay.
    $0 or $1 188 copay for each Medicare-covered hospital stay*
    $0 copay for each additional hospital day.
    30% of the cost for each hospital stay.**
    ** Outpatient Care **
    Doctor Office Visits
    $0 copay for each Medicare-covered primary care doctor visit.*
    0% or 20% of the cost for each Medicare-covered specialist visit.*
    30% of the cost for each Medicare-covered primary care doctor visit**
    30% of the cost for each Medicare-covered specialist visit**
    Outpatient Services
    0% or 20% of the cost for each Medicare-covered ambulatory surgical center visit*
    0% or 20% of the cost for each Medicare-covered outpatient hospital facility visit*
    30% of the cost for Medicare-covered outpatient hospital facility visits**
    30% of the cost for Medicare-covered ambulatory surgical center visits**
    Ambulance Services
    0% or 20% of the cost for Medicare-covered ambulance benefits.*
    30% of the cost for Medicare-covered ambulance benefits.**
    ** Outpatient Medical Services and Supplies **
    Durable Medical Equipment
    0% or 20% of the cost for Medicare-covered durable medical equipment*
    30% of the cost for Medicare-covered durable medical equipment**
    Diagnostic Tests, X-Rays, Lab Services, and Radiology Services
    $0 copay for Medicare-covered lab services*
    0% or 20% of the cost for Medicare-covered diagnostic procedures and tests*
    0% or 20% of the cost for Medicare-covered X-rays*
    0% or 20% of the cost for Medicare-covered diagnostic radiology services (not including X-rays)*
    0% or 20% of the cost for Medicare-covered therapeutic radiology services*
    30% of the cost for Medicare-covered therapeutic radiology services**
    30% of the cost for Medicare-covered outpatient X-rays**
    30% of the cost for Medicare-covered diagnostic radiology services**
    0% to 30% of the cost for Medicare-covered diagnostic procedures tests and lab services**
    ** Additional Benefits **
    Over-the-Counter Items
    Please visit our plan website to see our list of covered Over-the-Counter items. OTC items may be purchased only for the enrollee. Please contact the plan for specific instructions for using this benefit.
    Transportation
    $0 copay for up to 24 one-way trip(s) to plan approved location every year
    75% of the cost for transportation.




    Medicare Supplements
    fill the gaps in your
    Original Medicare
    1. Enter Your ZIP Code:
    » Medicare Supplement FAQs





    Ask a Pharmacist*
    Have questions about your medication?

    » Answers to Your Medication Questions, Free!
    Available Monday - Friday
    8am to 5pm MST
    *A free service included with your no cost drug discount card.


    © Q1Group LLC 2005 - 2024  



    Tips & Disclaimers
    • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
    • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
    • Medicare has neither reviewed nor endorsed the information on our site.
    • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
    • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
    • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
    • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
    • Limitations, copayments, and restrictions may apply.
    • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
      Statement required by Medicare:
      "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
    • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
    • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
    • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
    • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
    • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
    • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
    • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
    • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
    • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
    • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
    • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
    • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
    • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
    • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
    • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
    .