AARP Medicare Advantage Patriot No Rx CO-MA03 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H2406-107-000
Colorado Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.
Learn more about Colorado Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
|Monthly plan premium||$0.00|
|Initial drug coverage limit||$0.00|
|Catastrophic drug coverage limit||$8,000.00|
|Primary care doctor visit|
Doctor Office Visit:
Copayment for Medicare Covered Primary Care Office Visit $35.00
|Specialty doctor visit|
Doctor Specialty Visit:
Copayment for Medicare Covered Physician Specialist Office Visit $75.00
|Inpatient hospital care||In-Network:|
Acute Hospital Services:
$295.00 per day for days 1 to 6
$0.00 per day for days 7 to 90
Prior Authorization Required for Acute Hospital Services
Copayment for Urgent Care $0.00 to $40.00
Benefit Details - General 4b Note - NOTE ON COST SHARING RANGE FOR URGENTLY NEEDED SERVICES: $0 copayment applies to Medicare covered telehealth. The higher cost share applies to all other Medicare covered services.
Copayment for Worldwide Urgent Coverage $0.00
|Emergency room visit|
Copayment for Emergency Care $120.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours
Copayment for Worldwide Emergency Coverage $0.00
Copayment for Worldwide Emergency Transportation $0.00
Copayment for Ground Ambulance Services $275.00
Copayment for Air Ambulance Services $275.00
Benefit Details - 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
AARP Medicare Advantage Patriot No Rx CO-MA03 (PPO) covers a range of additional benefits. Learn more about AARP Medicare Advantage Patriot No Rx CO-MA03 (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
Copayment for Medicare Covered Chiropractic Services $75.00
|Diabetes supplies, training, nutrition therapy and monitoring||In-Network:|
Diabetic Supplies and Services:
Copayment for Medicare-covered Diabetic Supplies $0.00
Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20%
Prior Authorization Required for Diabetic Supplies and Services
Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage)
|Durable medical equipment (DME)|
Durable Medical Equipment:
Coinsurance for Medicare Covered Durable Medical Equipment 50%
|Diagnostic tests, lab and radiology services, and X-rays|
Outpatient Diag Procs/Tests/Lab Services:
Coinsurance for Medicare Covered Diagnostic Procedures/Tests 40%
Copayment for Medicare Covered Lab Services $0.00
Coinsurance for Medicare Covered Diagnostic Radiological Services 40%
Coinsurance for Medicare Covered Therapeutic Radiological Services 40%
Copayment for Medicare Covered Outpatient X-Ray Services $30.00
|Home health care|
Home Health Services:
Coinsurance for Medicare Covered Home Health 50%
|Mental health inpatient care|
$500.00 per day for days 1 to 20
$0.00 per day for days 21 to 90
|Mental health outpatient care|
Outpatient Mental Health Services:
Copayment for Medicare Covered Individual Sessions $30.00 to $40.00
Copayment for Medicare Covered Group Sessions $30.00 to $40.00
Outpatient Hospital and ASC Services:
Coinsurance for Medicare Covered Outpatient Hospital Services 40%
Coinsurance for Medicare Covered Ambulatory Surgical Center Services 40%
|Outpatient substance abuse care||In-Network:|
Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $0.00 to $25.00
Copayment for Medicare-covered Group Sessions $15.00
Prior Authorization Required for Outpatient Substance Abuse Services
Over-The-Counter (OTC) Items:
Copayment for Non-Medicare Covered Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $65.00
Copayment for Medicare-Covered Podiatry Services $45.00
Copayment for Routine Foot Care $45.00
|Skilled Nursing Facility (SNF) care||In-Network:|
Skilled Nursing Facility Services:
$0.00 per day for days 1 to 20
$203.00 per day for days 21 to 100
Prior Authorization Required for Skilled Nursing Facility Services
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Medicare Covered Dental Services:
Coinsurance for Medicare Covered Comprehensive Dental 40%
Non-Medicare Covered Dental Services:
Copayment for Non-Medicare Covered Preventive Dental $0.00
Coinsurance for Non-Medicare Covered Comprehensive Dental 0% to 50%
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Medicare Covered Vision Services:
Copayment for Medicare Covered Eye Exams $75.00
Coinsurance for Medicare Covered Eyewear 40%
Non-Medicare Covered Vision Services:
Copayment for Non-Medicare Covered Eye Exams $75.00
Copayment for Non-Medicare Covered Eyewear $0.00
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Copayment for Medicare Covered Benefits $0.00
Copayment for Routine Hearing Exams $0.00
Copayment for Hearing Aids $99.00 to $1249.00
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
|Preventive services and health/wellness education programs|
Medicare-covered Zero Dollar Preventive Services:
Coinsurance for Medicare Covered Medicare-covered Preventive Services 0% to 40%
When reviewing Colorado 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 Colorado that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
|Links to plan documents|
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
Every 60 seconds, we help someone enroll in a Medicare Advantage plan.1
Or call a licensed insurance agent1-800-557-6059
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