5

5 out of 5 stars* for plan year 2024

Plan ID: H0271-004

What You Need to Know:

  • UnitedHealthcare Medicare Advantage Assure (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $25, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is .
  • The plan includes an out-of-pocket maximum of $7,550 per year (in-network).
  • UnitedHealthcare Medicare Advantage Assure (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $25.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$25

Monthly Premium

Medicare Plan Features
Monthly Premium: $25.40
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$25.40 $0 $25.40 $0 $25.40 $445.0 0.0
Gap Coverage: No
Benchmark: below the regional benchmark
Type of Medicare Health: Defined Standard Benefit
Health Plan Type: Local PPO
Similar Plan: H0271-007
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: No additional gap coverage, only the Donut Hole Discount
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $7,550
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Jo Daviess, Illinois: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
15 members New plan - No summary rating as of yet. 5 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,668 drugs
Number of Members Enrolled in this Plan in Jo Daviess, Illinois: 10,333 members
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$0.00 $25.40 $0.00 $25.40
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$0.00 $19.00 $19.00 $12.70 $12.70 $6.30 $6.30
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
303 25% 679 25% 870 25% 1015 25% 801 25%

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AARP Medicare Advantage Walgreens (PPO) (2023)Local PPO$5,900$250
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Health Alliance Medicare HMO 40 Rx (HMO) (2023)Local HMO$4,700$0
4
Health Alliance Medicare POS 10 Rx (HMO-POS) (2023)Local HMO$4,500$0
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Humana Gold Choice H8145-121 (PFFS) (2023)PFFS *$-$-
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Health Alliance Medicare POS Basic Rx (HMO-POS) (2023)Local HMO$6,700$0
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Humana Gold Choice H8145-008 (PFFS) (2023)PFFS$-$380
4
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$5,900$-
5
Aetna Medicare Explorer Value (PPO) (2023)Local PPO$5,900$0
5
Health Alliance Medicare HMO 20 Rx (HMO) (2023)Local HMO$4,000$0
4
Health Alliance Medicare POS Basic (HMO-POS) (2023)Local HMO *$6,700$-
4
Health Alliance Medicare HMO Basic Rx (HMO) (2023)Local HMO$6,700$0
4
Aetna Medicare Premier Advantra (PPO) (2023)Local PPO$5,500$0
5
HumanaChoice R5361-001 (Regional PPO) (2023)Regional PPO *$6,700$-
5
Aetna Medicare Value Advantra (PPO) (2023)Local PPO$5,900$0
5
HumanaChoice R5361-002 (Regional PPO) (2023)Regional PPO$6,700$420
5
AARP Medicare Advantage (HMO-POS) (2023)Local HMO$3,900$0
5
Medical Associates Community Plan (Cost) (2023)Cost *$-$-
4
Medical Associates SmartPlan (Cost) (2023)Cost *$-$-
4
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$3,400$0
5
Medical Associates Freedom Plan (Cost) (2023)Cost *$-$-
4
Health Alliance Medicare POS 30 Rx (HMO-POS) (2023)Local HMO$5,500$0
4
SwedishAmerican Quartz Med Advantage Value (HMO) (2023)Local HMO *$4,900$-
3
Medicare Advantage Plans by UnitedHealthcare
AARP Medicare Advantage Walgreens (PPO) (2023)Local PPO$5,900$250
5
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$5,900$-
5
AARP Medicare Advantage (HMO-POS) (2023)Local HMO$3,900$0
5
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$3,400$0
5

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