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Effective URL: https://www.aarpmedicareplans.com/health-plans/medicare-advantage-plans/available-plans.html?planId=H5253087000&planYear=2022&syst...
Submission: On March 12 via api from CH — Scanned from DE
Effective URL: https://www.aarpmedicareplans.com/health-plans/medicare-advantage-plans/available-plans.html?planId=H5253087000&planYear=2022&syst...
Submission: On March 12 via api from CH — Scanned from DE
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Skip to main content AARP Medicare Plans from UnitedHealthcare United Healthcare UnitedHealthcare Insurance Company or an affiliate or an affiliate AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company, or UnitedHealthcare Insurance Company of America, or United Healthcare Insurance Company of New York. (UnitedHealthcare) * AARP Membership Join AARP - Opens in new tab Renew AARP Membership - Opens in new tab AARP Member Benefits - Opens in new tab * 1-855-608-8765 TFN Modal Close QUESTIONS? WE'RE READY TO HELP. Call UnitedHealthcare at: 1-855-970-1217FED TFN (TTY 711) (toll free) 8 a.m. - 8 p.m., 7 days a week.* *Alaska and Hawaii: 8 a.m. - 8 p.m. Monday - Friday, 8 a.m. - 5 p.m. Saturday and Sunday Already a member? Call the number on the back of your member ID card. MO10050ST Call UnitedHealthcare at: 1-855-938-4548MEDSUPP TFN (TTY 711) (toll free) 7 a.m. - 11 p.m. ET, Monday - Friday 9 a.m. - 5 p.m. ET, Saturday. Already a member? Call the number on the back of your member ID card. MO10050ST * For Plan Members Are you a Plan Member? Go to the Member Site to Sign In or Register for an account. Go to the Member Site - Opens in new tab Search My Saved Items Saved MY SAVED ITEMS WELCOME This plan has been saved to your profile. A plan has been removed from your profile. No plans or drugs have been saved. View Saved Items View Saved Items -------------------------------------------------------------------------------- Add a Drug Add a Plan Sign In to see your saved items Sign Out Menu Search Back Enter Search Search MAIN MENU Search * Home * Shop For a Plan Back SHOP FOR A PLAN SHOP Get help making the right decision when shopping for coverage. ENROLL Ready to enroll? Need to brush up on enrollment basics? See more here. MEMBER RESOURCES Get plan information, forms and documents you may need now or in the future. Plan Types MEDICARE ADVANTAGE PLANS DUAL SPECIAL NEEDS PLANS [[STATE-START:AL,AS,AK,AZ,AR,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,MP,NV,NH,NJ,NM,NY,NC,ND,OH,OK,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,VA,WA,DC,WV,WI,WY,NULL]]MEDICARE SUPPLEMENT PLANS [[STATE-END]] [[STATE-START:OR]]MEDICARE SUPPLEMENT PLANS [[STATE-END]] MEDICARE PRESCRIPTION DRUG PLANS Plan Types Back SHOP FOR A PLAN Plan Types MEDICARE ADVANTAGE PLANS DUAL SPECIAL NEEDS PLANS [[STATE-START:AL,AS,AK,AZ,AR,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,MP,NV,NH,NJ,NM,NY,NC,ND,OH,OK,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,VA,WA,DC,WV,WI,WY,NULL]]MEDICARE SUPPLEMENT PLANS [[STATE-END]] [[STATE-START:OR]]MEDICARE SUPPLEMENT PLANS [[STATE-END]] MEDICARE PRESCRIPTION DRUG PLANS Tools to help you choose a plan GET A PLAN RECOMMENDATION ESTIMATE DRUG COSTS SEARCH FOR A PHARMACY SEARCH DOCTORS - OPENS IN NEW TAB SEARCH DENTISTS - OPENS IN NEW TAB Tools to help you choose a plan Back SHOP FOR A PLAN Tools to help you choose a plan GET A PLAN RECOMMENDATION ESTIMATE DRUG COSTS SEARCH FOR A PHARMACY SEARCH DOCTORS - OPENS IN NEW TAB SEARCH DENTISTS - OPENS IN NEW TAB FIND PLANS IN YOUR AREA Your ZIP Code Find Plans Error: Please enter a valid ZIP Code Need help finding a ZIP Code? Look up ZIP Code Request More Help and Information * Learn About Medicare Back LEARN ABOUT MEDICARE Introduction to Medicare Introduction Eligibility Coverage Options Prescriptions, Providers & Benefits Medicare Cost Basics Introduction to Medicare Back LEARN ABOUT MEDICARE Introduction to Medicare Introduction Eligibility Coverage Options Prescriptions, Providers & Benefits Medicare Cost Basics Types of Plans Overview of Plans Medicare Advantage Plans Medicare Supplement Insurance Medicare Prescription Drug Plans Special Needs Plans Types of Plans Back LEARN ABOUT MEDICARE Types of Plans Overview of Plans Medicare Advantage Plans Medicare Supplement Insurance Medicare Prescription Drug Plans Special Needs Plans Medicare Enrollment When to Enroll How to Enroll Changing Plans Working Past 65 Medicare Enrollment Back LEARN ABOUT MEDICARE Medicare Enrollment When to Enroll How to Enroll Changing Plans Working Past 65 More about Medicare Articles and Special Topics More about Medicare Back LEARN ABOUT MEDICARE More about Medicare Articles and Special Topics FAQ Medicare FAQ Glossary FAQ Back LEARN ABOUT MEDICARE FAQ Medicare FAQ Glossary GET YOUR FREE MEDICARE GUIDE Learn more about how Medicare works, coverage options and when to enroll. THANK YOU! Your guide will arrive in your inbox shortly. Your email address Error: Please enter a valid email address. Submit Error: Please enter a valid email address. Are you a Plan Member? Go to the Member Site to Sign In or Register for an account. Go to the Member Site - - Opens in new tab AARP Membership Back AARP MEMBERSHIP Join AARP Renew AARP Membership AARP Member Benefits My Saved Items You are in Agent mode OUR MEDICARE PLAN TYPES Back to all plans * Print Plan Details opens in new window * Email Plan Details opens in new window 2022 Medicare Advantage Plan Details AARP MEDICARE ADVANTAGE PLAN 1 (HMO-POS) H5253-087 WHAT IS POS? A TYPE OF HMO PLAN, POINT OF SERVICE (POS) PLANS LET YOU RECEIVE CERTAIN SERVICES FROM DOCTORS OR HOSPITALS THAT ARE NOT IN THE PLANS NETWORK, GENERALLY AT A HIGHER CO-PAYMENT OR CO-INSURANCE. Save Plan Saved Enroll in plan Learn more Add to compare 1 plan added, please select another plan to continue Medical Benefits and Programs Prescription Drug Benefits Plan Costs ELIGIBILITY footnotefootnote2 MEDICAL BENEFITS The table below shows you the medical benefits that may be available with this Medicare Advantage plan. To see a full list of benefits, including any covered out-of-network services, please see the Benefit Highlights (PDF) or Evidence of Coverage (PDF) for this plan. Monthly Premium1 $0 Annual Medical Deductible The pre-set, fixed amount you must pay for health care costs before the insurance company or Medicare begins to pay. Please see your Evidence of Coverage for details. $0 Out of Pocket Maximum This is the highest amount of money you have to pay out of your pocket for cost sharing (copayments and coinsurance) charged for certain covered services during a calendar year. Not all copayments or coinsurance amounts you pay apply toward the annual out-of-pocket maximum. See the plan's Evidence of Coverage (EOC) for more information. $4,500 Doctors & Dentists Are my doctors & dentist covered 0 out of Doctors & Dentists covered Edit my Doctors & Dentists Learn More Out-of-Network Benefits Out-of-Network Benefits available for dental only Opens in a new window National Network Yes Primary Care Provider $0 copay Specialist $25 copay Referral Required No Preventive Services $0 copay for covered services 1 Inpatient Hospital Care $245 copay per day: Days 1-6; $0 copay per day for unlimited days after that Skilled Nursing Facility $0 copay per day: Days 1-20 $188 copay per day: Days 21-44 $0 copay per day: Days 45-100 Ambulatory Surgical Center $0 copay - $245 copay 2 Outpatient Hospital Services (includes observation services) $0 copay - $245 copay 2 Mental Health (outpatient) Group: $15 copay Individual: $25 copay Diabetes Monitoring Supplies $0 copay for covered brands 2 Home Health Care $0 copay Diagnostic Radiology Services (such as MRIs/CT scans, etc.) $0 copay - $170 copay Diagnostic Tests and Procedures (non-radiological) $20 copay Lab Services $0 copay Outpatient X-rays $15 copay Air Ambulance Services $250 copay Ground Ambulance Services $250 copay Emergency Care $90 copay Urgent Care $40 copay Opioid Treatment Services $0 copay ADDITIONAL BENEFITS AND PROGRAMS NOT COVERED UNDER ORIGINAL MEDICARE The table below shows you some additional benefits and programs that may be available with this Medicare Advantage plan. To see a full list of benefits, please see the Benefit Highlights (PDF) or Evidence of Coverage (PDF) or documents in the "Plan Documents" section below. View Out-of-Network Coverage View In-Network Coverage In-Network Out-of-Network Annual Routine Physical $0 copay 2 No Coverage Eye Exam $0 copay; 1 every year 1 No Coverage Routine Eyewear $0 copay; up to $200 every two years for frames or contact lenses. Standard single, bifocal, trifocal, or progressive lenses are covered in full. Home delivered eyewear available nationwide only through UnitedHealthcare Vision (select products only). 1 Routine Dental $1,500 limit on covered Preventive and Comprehensive dental services Click here for details Is my dentist covered for this plan? - Opens in new window Foot Care - Routine $25 copay 1 No Coverage Hearing Exam $0 copay 1 No Coverage Hearing Aids $375 copay - $1,425 copay for each hearing aid provided through UnitedHealthcare Hearing, up to 2 hearing aids every year. Includes hearing aids delivered directly to you with virtual follow-up care through Right2You (select models), offered only by UnitedHealthcare Hearing. 1 Transportation 24 one-way trips to or from plan approved location with no additional cost. No Coverage Fitness Program through Renew Active ® Fitness Membership Only: Basic membership in a fitness program at a network location at no additional cost Over-the-Counter (OTC) Products Catalog $120 credit per quarter to use on approved over-the-counter products. 2 Meal Benefit $0 copay; Meals provided immediately after an inpatient hospital or skilled nursing facility stay. Nursing Hotline Speak with a Registered Nurse (RN) 24 hours a day, 7 days a week. 1 Virtual Medical Visits $0 copay; Speak to network telehealth providers using your computer or mobile device. Virtual Mental Health Visits $0 copay; Speak to network telehealth providers using your computer or mobile device. footnotefootnote1Benefits, features and/or devices may vary by plan/area. Limitations and exclusions apply. See Summary of Benefits (PDF) for details. footnotefootnote2Benefits, features and/or devices may vary by plan/area. Limitations and exclusions apply. See Evidence of Coverage (PDF) for details. PDF (Portable Document Format) documents can be viewed with Adobefootnotefootnote® Readerfootnotefootnote®. If you don't already have this viewer on your computer, download it free from the Adobe website. For plans offering a OTC and Healthy Food benefits: OTC and Healthy Food benefits have expiration timeframes. Call the plan or refer to your Evidence of Coverage (EOC) for more information. For plans offering a Fitbit benefit: Choose one device from approved select models every 2 years. Devices may vary by plan/area. Limitations and exclusions apply. Fitbit, the Fitbit logo, and related marks and logos are trademarks of Google LLC and/or its affiliates. See if your doctor & dentist is covered in your ZIP code. Look up my doctor & dentist 0 out of Doctors & dentists covered Edit my doctor & dentist Dual Lookalike (lifetime reserve days) $0 copay per day for unlimited days after that Save Plan Saved Enroll in Plan Learn more Add to Compare 1 plan added, please select another plan to continue Back to all plans PLAN DOCUMENTS The following documents can help you get more information about this Medicare Advantage plan, enroll in a plan and more. All documents are PDF (Portable Document Format) files. They can be viewed with Adobe® Reader®. If you don't already have this viewer on your computer, download it free from the Adobe website. ENGLISH GENERAL PLAN INFORMATION Enrollment Form (PDF)Opens in new tab Summary of Benefits (PDF)Opens in new tab Evidence of Coverage (PDF)*Opens in new tab Star Ratings (PDF)Opens in new tab Annual Notice of Changes (ANOC) (PDF)5 Opens in new tab Benefit HighlightsOpens in new tab MEDICAL PROVIDERS Provider Directory (PDF)Opens in new tab Vendor Information Sheet (PDF)Opens in new tab PRESCRIPTION DRUG COVERAGE Comprehensive Formulary (PDF) (Updated 02/02/2022)Opens in new tab Prior Authorization Criteria (PDF) Opens in new tab Step Therapy Criteria (PDF)Opens in new tab Formulary Additions (PDF)Opens in new tab Formulary Deletions (PDF)Opens in new tab Alternative Drugs List (PDF)Opens in new tab PHARMACY DIRECTORY ONLINE PHARMACY DIRECTORY OTHER LANGUAGES GENERAL PLAN INFORMATION Formulario de Inscripción (PDF)Opens in new tab Resumen de Beneficios (PDF)Opens in new tab Comprobante de Cobertura (PDF)* (Actualizado 11/01/2021)Opens in new tab Clasificación de la Calidad del Plan (PDF)Opens in new tab Aviso Annual de Cambios (PDF)5 Opens in new tab Beneficios ImportantesOpens in new tab MEDICAL PROVIDERS Directorio de Proveedores (PDF)Opens in new tab Información sobre proveedores - Spanish (PDF)Opens in new tab Prescription Drug Coverage Formulario Completo (PDF) (Actualizado 02/03/2022)Opens in new tab Lista de Medicamentos Alternativos - Spanish (PDF)Opens in new tab Pharmacy Directory DIRECTORIO DE FARMACIAS EN INTERNET 網站查詢網上藥房名冊 NEED HELP? CALL US Call UnitedHealthcare toll-free at 1-855-970-1217 (TTY 711) [[state-start:AL,CA,AZ,AR,CO,CT,DE,FL,GA,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,RI,SC,SD,TN,TX,UT,VT,VA,WA,WV,WI,WY,DC]][[state-end]] [[state-start:AK,HI]][[state-end]] FIND A SALES AGENT Find an agent in your area - Opens in new window GET A FREE MEDICARE GUIDE Enter your information to receive a free guide that includes how Medicare works, coverage options and more! First Name Please enter a valid first name. Last Name Please enter a valid last name. Email Address Please enter a valid email address. Submit GET HELP CHOOSING A PLAN Answer a few simple questions and we'll help you find plan options that may be a good fit for you. Start Now FOOTNOTES footnotefootnote1 The amount shown does not include the Part B premium you already pay to the government. Your plan costs, including premiums and drug costs, may be different if you get Extra Help from the government or if you have Medicaid. For more information, see "Can I Get Help with my Medicare Prescription Drug Costs?". Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. footnotefootnote2 Amounts may vary depending on the level of care provided or the type of health care services you receive. 3 Point of Service (POS) plans offer you the option to receive care from out-of-network providers; however, you will generally have a higher copay or higher coinsurance if you choose to go out-of-network. Find important information about Medicare Advantage coverage determinations and appeals, quality assurance policies, grievances, drug conditions and limitations. View Medicare Advantage (Part C) coverage determinations and appeals process. Learn about prescription drug coverage determinations and appeals, prior authorization criteria, step therapy criteria and the 60-day formulary change notice. View prescription drug (Part D) coverage determinations and appeals process. View the UnitedHealthcare Prescription Drug Transition Process. Enrollment Disclaimer Information Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll. AARP encourages you to consider your needs when selecting products and does not make specific product or pharmacy recommendations for individuals. UnitedHealthcare contracts directly with Walgreens for this plan; AARP and its affiliates are not parties to that contractual relationship. AARPfootnotefootnote® Medicare Advantage Walgreens LPPO and HMO plans: UnitedHealthcare contracts directly with Walgreens for this plan; AARP and its affiliates are not parties to that contractual relationship. The plan's pharmacy network includes limited lower-cost, preferred pharmacies in rural ID and OR. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-877-648-2359 (TTY 711), 8 a.m.–8 p.m., 7 days a week or consult the online pharmacy directory. Fitbit: Choose one device from approved select models every 2 years. Devices may vary by plan/area. Limitations and exclusions apply. Fitbit, the Fitbit logo, and related marks and logos are trademarks of Google LLC and/or its affiliates. Network: Network size varies by plan and market. Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply. PERS: Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply. You must have a working landline and/or cellular phone coverage to use PERS. Renew Active: Participation in the Renew Activefootnotefootnote® program is voluntary. Consult your doctor prior to beginning an exercise program. Renew Active includes standard fitness membership. The Renew Active program varies by plan/area. Access to gym and fitness location network may vary by location and plan. Renew Active premium gym and fitness location network only available with certain plans. [[state-start:AL,CA,AZ,AR,CO,CT,DE,FL,GA,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,RI,SC,SD,TN,TX,UT,VT,VA,WA,WV,WI,WY,DC]][[state-end]] [[state-start:AK,HI]][[state-end]] This information is available for free in other languages. Please contact Customer Service for additional information. Esta información está disponible sin costo en otros idiomas. Para obtener más información comuníquese con nuestro Servicio al Cliente. 本資訊可以其他語言免費提供。如需更多資訊，請聯絡客戶服務部。 Every year, Medicare evaluates plans based on a 5-star rating system. FOOTNOTES footnotefootnote1 Your plan costs, including premiums and drug costs, may be different if you get Extra Help from the government or if you have Medicaid. For more information, see "Can I Get Help with my Medicare Prescription Drug Costs?" footnotefootnote2 This document is the Annual Notice of Changes for this plan. If you are a current plan member and have been switched to a different plan, this document may not apply to you. If you have any questions, please call Customer Service at the number on your member ID card. footnotefootnote3 OptumRx home delivery is not available in Guam, American Samoa, U.S. Virgin Islands or Northern Mariana Islands. MORE INFORMATION The list of covered drugs was last updated on 02/02/2022. Note: Prescription drugs that are not covered by the plan or that cannot be provided as part of standard Medicare prescription drug coverage are shown as "not covered" in the chart. Copay or coinsurance amounts may change if you have a limited income. The drug costs displayed are estimates and may vary based on the specific quantity, strength and/or dosage of the medication and the pharmacy you use. It may be important to look beyond your current needs at the value of having Medicare prescription drug insurance. Enrolling when you become eligible will help give you peace of mind, should your drug needs become more significant in the future. It may also help you avoid the Medicare late enrollment penalty. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Amounts displayed do not include taxes or injection fees. During the Coverage Gap, amounts displayed for brand name drugs include a 70% manufacturer discount. However, this discount is based on pharmaceutical manufacturers' participation and may not apply to all brand drugs. You pay 25% of the total cost for brand name drugs, for any drug tier during the Coverage Gap. The 25% drug coinsurance within the Coverage Gap is based on an assessment that the drug is defined as a generic drug according to Part D rules. If your drug is not eligible for coverage under Medicare Part D, you will pay the full cost of the drug. PREFERRED MAIL HOME DELIVERY THROUGH OPTUMRX Savings Benefit Savings apply during the Initial Coverage period, which begins after the payment of your required deductible (if any) and ends when the total cost of your drugs (paid by UnitedHealthcare, you and others) reaches . NOTE: OptumRx home delivery is not available in Guam, American Samoa, U.S. Virgin Islands or Northern Mariana Islands. AARP® MedicareRx Preferred (PDP) and AARP® MedicareRx Saver Plus (PDP)’s pharmacy network includes limited lower-cost, preferred pharmacies in rural AK, MT, NE, ND, SD and WY. There are an extremely limited number of preferred cost share pharmacies in suburban MT. AARP MedicareRx Walgreens (PDP)’s pharmacy network offers limited access to pharmacies with preferred cost sharing in urban ND; suburban HI, ND, PA and rural AK, AR, HI, IA, ID, KS, MN, MS, MT, NE, OK, OR, PA, SD, and WY. There are an extremely limited number of preferred cost share pharmacies in suburban MT and rural ND. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-877-308-0777 (TTY 711), 8 a.m.–8 p.m., 7 days a week or consult the online pharmacy directory. NOTE: If you are receiving Extra Help from Medicare, your copays may be lower or you may have no copays. The pharmacy directory is current as of the first Sunday of each month. All pharmacies may not be listed in this directory. Inclusion of a pharmacy does not guarantee that the pharmacy is open, is at the same location as listed in this online directory, or is included in the network. The pharmacy network may change at any time. You will receive notice when necessary. Pharmacies on this list are called “network pharmacies” because UnitedHealthcare has made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under your plan only if they are filled at a network pharmacy or through our mail order pharmacy service. You are not required to continue using the same pharmacy to fill your prescriptions and may switch to any other network pharmacy. Prescriptions can be filled at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and your plan’s formulary. Please contact UnitedHealthcare for details. UnitedHealthcare has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. AARP MedicareRx Walgreens prescription drug plan: Member may use any pharmacy in the network but may not receive the same pricing as Walgreens or Duane Reade, the plan's preferred retail pharmacies. Walgreens pharmacies may not be available in all areas. Duane Reade is only available in NY and NJ. Tier 2-5 member cost share applies after deductible. $15 or more savings for the AARP MedicareRx Walgreens (PDP) plan applies to Tier 1 when filled at a Walgreens or Duane Reade preferred retail pharmacy compared to a standard network pharmacy. AARP MedicareRx Preferred and Saver Plus (PDP) plans: Member may use any pharmacy in the network but may not receive preferred retail pharmacy pricing. Pharmacies in the Preferred Retail Pharmacy Network may not be available in all areas. Copays apply after deductible. Note: The Preferred Retail Pharmacy Network is not available in Guam, American Samoa, U.S. Virgin Islands or Northern Mariana Islands. Learn about prescription drug coverage determinations and appeals, prior authorization criteria, step therapy criteria and the 60-day formulary change notice. View prescription drug (Part D) coverage determinations and appeals process. View the UnitedHealthcare Prescription Drug Transition Process. Enrollment Disclaimer Information Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll. AARP encourages you to consider your needs when selecting products and does not make specific product or pharmacy recommendations for individuals. AARP MedicareRx Walgreens (PDP) plans: UnitedHealthcare contracts directly with Walgreens for this plan; AARP and its affiliates are not parties to that contractual relationship. [[state-start:AL,CA,AZ,AR,CO,CT,DE,FL,GA,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,RI,SC,SD,TN,TX,UT,VT,VA,WA,WV,WI,WY,DC]] [[state-start:AK,HI]] This information is available for free in other languages. Please contact Customer Service for additional information. Esta información está disponible sin costo en otros idiomas. Para obtener más información comuníquese con nuestro Servicio al Cliente. 本資訊可以其他語言免費提供。如需更多資訊，請聯絡客戶服務部。 Every year, Medicare evaluates plans based on a 5-star rating system. FOOTNOTES footnotefootnote1 The amount shown does not include the Part B premium you already pay to the government. Your plan costs, including premiums and drug costs, may be different if you get Extra Help from the government or if you have Medicaid. For more information, see "Can I Get Help with my Medicare Prescription Drug Costs?". Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. footnotefootnote2 Amounts may vary depending on the level of care provided or the type of health care services you receive. 3 Point of Service (POS) and Preferred Provider Organization (PPO) plans offer you the option to receive care from out-of-network providers; however, you will generally have a higher copay or higher coinsurance if you choose to go out-of-network. 4 Drugs and prices may vary between pharmacies and are subject to change during the plan year. Prices are based on quantity filled at the pharmacy. Quantities may be limited by pharmacy based on their dispensing policy or by the plan based on Quantity Limit requirements; if prescription is in excess of a limit, copay amounts may be higher. 6 This document is the Annual Notice of Changes for this plan. If you are a current plan member and have been switched to a different plan, this document may not apply to you. If you have questions, please call Customer Service at the number on the back of your member ID card. 7 Skilled Nursing: These are 2021 Medicare-defined amounts and may change for 2022. MORE INFORMATION The list of covered drugs was last updated on 02/02/2022. Note: Prescription drugs that are not covered by the plan or that cannot be provided as part of standard Medicare prescription drug coverage are shown as "not covered" in the chart. Copay or coinsurance amounts may change if you have a limited income. The drug costs displayed are estimates and may vary based on the specific quantity, strength and/or dosage of the medication and the pharmacy you use. It may be important to look beyond your current needs at the value of having Medicare prescription drug insurance. Enrolling when you become eligible will help give you peace of mind, should your drug needs become more significant in the future. It may also help you avoid the Medicare late enrollment penalty. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. NOTE: If you are receiving Extra Help from Medicare, your copays may be lower or you may have no copays. The pharmacy directory is current as of the first Sunday of each month. All network pharmacies may not be listed in this directory. Inclusion of a pharmacy does not guarantee that the pharmacy is open, is at the same location as listed in this online directory, or is included in the network. The pharmacy network may change at any time. You will receive notice when necessary. Pharmacies on this list are called “network pharmacies” because UnitedHealthcare has made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under your plan only if they are filled at a network pharmacy or through our mail order pharmacy service. You are not required to continue using the same pharmacy to fill your prescriptions and may switch to any other network pharmacy. Prescriptions can be filled at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and your plan’s formulary. Please contact UnitedHealthcare for details. UnitedHealthcare has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. During the Coverage Gap, amounts displayed for brand name drugs include a 70% manufacturer discount. However, this discount is based on pharmaceutical manufacturers' participation and may not apply to all brand drugs. You pay 25% of the total cost for brand name drugs, for any drug tier during the Coverage Gap. The 25% drug coinsurance within the Coverage Gap is based on an assessment that the drug is defined as a generic drug according to Part D rules. If your drug is not eligible for coverage under Medicare Part D, you will pay the full cost of the drug. PREFERRED MAIL HOME DELIVERY THROUGH OPTUMRX Savings Benefit Savings apply during the Initial Coverage period, which begins after the payment of your required deductible (if any) and ends when the total cost of your drugs (paid by UnitedHealthcare, you and others) reaches . Find important information about Medicare Advantage coverage determinations and appeals, quality assurance policies, grievances, drug conditions and limitations. View Medicare Advantage (Part C) coverage determinations and appeals process. Learn about prescription drug coverage determinations and appeals, prior authorization criteria, step therapy criteria and the 60-day formulary change notice. View prescription drug (Part D) coverage determinations and appeals process. View the UnitedHealthcare Prescription Drug Transition Process. Enrollment Disclaimer Information Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. For Medicare Advantage and/or Prescription Drug Plans: A Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. For Dual Special Needs Plans: A Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan's contract renewal. Fitbit: Choose one device from approved select models every 2 years. Devices may vary by plan/area. Limitations and exclusions apply. Fitbit, the Fitbit logo, and related marks and logos are trademarks of Google LLC and/or its affiliates. Network: Network size varies by plan and market. Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply. PERS: Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply. You must have a working landline and/or cellular phone coverage to use PERS. Renew Active: Participation in the Renew Activefootnotefootnote® program is voluntary. Consult your doctor prior to beginning an exercise program. Renew Active includes standard fitness membership. The Renew Active program varies by plan/area. Access to gym and fitness location network may vary by location and plan. Renew Active premium gym and fitness location network only available with certain plans. [[state-start:AL,CA,AZ,AR,CO,CT,DE,FL,GA,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,RI,SC,SD,TN,TX,UT,VT,VA,WA,WV,WI,WY,DC]][[state-end]] [[state-start:AK,HI]][[state-end]] This information is available for free in other languages. Please contact Customer Service for additional information. Esta información está disponible sin costo en otros idiomas. Para obtener más información comuníquese con nuestro Servicio al Cliente. 本資訊可以其他語言免費提供。如需更多資訊，請聯絡客戶服務部。 Every year, Medicare evaluates plans based on a 5-star rating system. UnitedHealthcare Senior Care Options (HMO SNP) Plan UnitedHealthcare Senior Care Options is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options program. Texas Disclaimer Information UnitedHealthcare Connected (Medicare - Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. Information Icon close external link PLAN SAVED Close Modal This plan has been saved to your guest profile. This will help you keep track of plans and get cost estimates based on your drugs and doctors. MO10051ST Keep Shopping Plans View Saved Plans SHOP PLANS Medicare Advantage Plans Dual Special Needs Plans [[state-start:null,AL,AS,AK,AZ,AR,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NC,ND,OH,OK,OR,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,WA,VA,DC,WV,WI,WY]]Medicare Supplement Insurance Plans [[state-end]] Medicare Prescription Drug Plans Shop Plans Medicare Advantage Plans Dual Special Needs Plans [[state-start:null,AL,AS,AK,AZ,AR,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NC,ND,OH,OK,OR,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,WA,VA,DC,WV,WI,WY]]Medicare Supplement Insurance Plans [[state-end]] Medicare Prescription Drug Plans TOOLS & RESOURCES Get a Plan Recommendation Estimate Drug Costs Search for a Pharmacy Search Doctors - Opens in new tab Search Dentists - Opens in new tab Tools & Resources Get a Plan Recommendation Estimate Drug Costs Search for a Pharmacy Search Doctors - Opens in new tab Search Dentists - Opens in new tab LEARN ABOUT MEDICARE Introduction to Medicare Eligibility Coverage Choices Medicare FAQ Learn About Medicare Introduction to Medicare Eligibility Coverage Choices Medicare FAQ MORE About Contact Language Assistance - Opens in new tab AARP.org - Opens in new tab More About Contact Language Assistance - Opens in new tab AARP.org - Opens in new tab ©2022 United HealthCare Services, Inc. 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