Plan ID: H2577-020

What You Need to Know:

  • UnitedHealthcare Medicare Advantage Choice (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 $0, 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 $5,900 per year (in-network).
  • UnitedHealthcare Medicare Advantage Choice (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 $0.

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
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:
$0 $0 $0 $0 $0 $0 0.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H2577-021
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): $5,900
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Sequatchie, Tennessee: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
13 members New plan - No summary rating as of yet. New plan - not yet rated. New plan - not yet rated.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,668 drugs
Number of Members Enrolled in this Plan in Sequatchie, Tennessee: 380 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 $0.00 $0.00 $0.00
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 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
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 $0.00 679 $8.00 870 $45.00 1015 $95.00 801 33%

Other Medicare Advantage Plans in Sequatchie, Tennessee

Plan Name Type Premium MOOP Rx Deduct. Rating
Aetna Medicare Value Plan (PPO) (2023)Local PPO$5,900$0
5
Amerivantage Classic Plus (HMO-POS) (2023)Local HMO$4,900$0
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BlueAdvantage Sapphire (PPO) (2023)Local PPO$5,700$0
2
HumanaChoice R7315-001 (Regional PPO) (2023)Regional PPO *$3,400$-
4
Amerivantage Balance Plus (HMO) (2023)Local HMO$6,700$445
New plan - not yet rated.
Humana Honor (PPO) (2023)Local PPO *$3,400$-
4
BlueAdvantage Diamond (PPO) (2023)Local PPO$3,700$0
2
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$3,700$0
5
HumanaChoice R7315-002 (Regional PPO) (2023)Regional PPO$6,700$400
4
BlueAdvantage Emerald (PPO) (2023)Local PPO$4,900$0
2
Cigna Premier Medicare (HMO-POS) (2023)Local HMO$6,700$200
4
AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$3,200$-
5
Humana Gold Plus H4461-030 (HMO-POS) (2023)Local HMO$3,900$0
4
HumanaChoice H5216-098 (PPO) (2023)Local PPO$6,700$150
4
Humana Gold Plus H4461-031 (HMO-POS) (2023)Local HMO$4,900$0
4
Aetna Medicare Premier Plan (PPO) (2023)Local PPO$7,500$0
5
Cigna Primary Medicare (HMO) (2023)Local HMO$6,700$445
4
Amerivantage Balance (HMO) (2023)Local HMO$6,700$445
5
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$3,200$0
5
WellCare Patriot (HMO-POS) (2023)Local HMO *$4,500$-
4
Humana Gold Plus H4461-036 (HMO-POS) (2023)Local HMO$5,900$0
4
BlueAdvantage Ruby (PPO) (2023)Local PPO$4,300$0
2
WellCare Dividend (HMO) (2023)Local HMO$6,700$0
4
Cigna True Choice Medicare (PPO) (2023)Local PPO$5,900$0
New plan - not yet rated.
Cigna Preferred Medicare (HMO) (2023)Local HMO$6,700$0
4
HumanaChoice H5216-180 (PPO) (2023)Local PPO$6,700$225
4
Humana Honor (HMO-POS) (2023)Local HMO *$5,900$-
4
Amerivantage Classic (HMO) (2023)Local HMO$6,500$0
5
Cigna Fundamental Medicare (HMO) (2023)Local HMO *$6,700$-
4
WellCare Compass (HMO) (2023)Local HMO$4,900$445
4
WellCare Value (HMO-POS) (2023)Local HMO$5,500$0
4
Medicare Advantage Plans by UnitedHealthcare
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$3,700$0
5
AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$3,200$-
5
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$3,200$0
5

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