UnitedHealthcare Chronic Complete (PPO C-SNP) - 2023 UnitedHealthcare (2024)

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H0271 - 052 - 0

UnitedHealthcare Chronic Complete (PPO C-SNP) - 2023 UnitedHealthcare (1) (4 / 5)

UnitedHealthcare Chronic Complete (PPO C-SNP)is a Medicare Advantage (Part C) Special Needs Plan by UnitedHealthcare.

This page features plan details for 2023 UnitedHealthcare Chronic Complete (PPO C-SNP)H0271 – 052 – 0 available in State of Missouri.

IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below:

2024 UHC Complete Care MO-0001 (PPO C-SNP) H0271 - 052 - 0

Locations

UnitedHealthcare Chronic Complete (PPO C-SNP)is offered in the following locations.

Click to see more locations

Plan Overview

UnitedHealthcare Chronic Complete (PPO C-SNP)offers the following coverage and cost-sharing.

Special Needs Plan Type:Chronic or Disabling Condition
Conditions Covered:
  • Cardiovascular Disorders, Chronic Heart Failure and Diabetes
  • Insurer:UnitedHealthcare
    Health Plan Deductible:$0.00
    MOOP:$8,500 In and Out-of-network
    $4,400 In-network
    Drugs Covered:Yes

    Ready to sign up for UnitedHealthcare Chronic Complete (PPO C-SNP)?

    Get help from a licensed insurance agent.

    Call 1-877-354-4611 TTY 711.

    8am – 11pm EST. 7 days a week

    Premium Breakdown

    UnitedHealthcare Chronic Complete (PPO C-SNP)has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium.The following is a breakdown of your monthly premium with Part B costs included.

    Part BPart CPart DPart B Give BackTotal
    $164.90$0.00$0.00$0.00$164.90

    Please Note:

    • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
    • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

    Drug Info

    UnitedHealthcare Chronic Complete (PPO C-SNP)provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

    Drug Deductible:$0.00
    Initial Coverage Limit:$4,660.00
    Catastrophic Coverage Limit:$7,400.00
    Drug Benefit Type:Enhanced
    Gap Coverage:Yes
    Formulary Link:Formulary Link

    Part D Premium Reduction

    The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.The table below shows how the LIS impacts the Part D premium of this plan.

    Part DLIS 25%LIS 50%LIS 75%LIS Full
    $0.00$43.40$34.80$26.30$17.70

    Initial Coverage Phase

    After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.

    30 Day

    60 Day

    90 Day

    30 Day

    60 Day

    90 Day

    Gap Coverage Phase

    After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.

    30 Day

    90 Day

    30 Day

    90 Day

    Tier Cost
    All other tiers (Generic)25%
    All other tiers (Brand-name)25%

    Catastrophic Coverage Phase

    After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

    Drug TypeCost Share
    Generic drugs$4.15 copay or 5% (whichever costs more)
    Brand-name drugs$10.35 copay or 5% (whichever costs more)

    Additional Benefits

    UnitedHealthcare Chronic Complete (PPO C-SNP)also provides the following benefits.

    Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    In-Network: No

    Dental (comprehensive)

    Diagnostic services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Diagnostic services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Endodontics:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Endodontics:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Extractions:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Extractions:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Non-routine services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Non-routine services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Periodontics:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Periodontics:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Prosthodontics, other oral/maxillofacial surgery, other services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Prosthodontics, other oral/maxillofacial surgery, other services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Restorative services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Restorative services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)

    Dental (preventive)

    Cleaning:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Cleaning:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Dental x-ray(s):In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Dental x-ray(s):Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Fluoride treatment:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Fluoride treatment:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Oral exam:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Oral exam:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)

    Diagnostic procedures/lab services/imaging

    Diagnostic radiology services (e.g., MRI):In-Network: $0-150 copay (authorization required) (referral not required)
    Diagnostic radiology services (e.g., MRI):Out-of-Network: $60-200 copay (authorization required) (referral not required)
    Diagnostic tests and procedures:In-Network: $20 copay (authorization required) (referral not required)
    Diagnostic tests and procedures:Out-of-Network: $20 copay (authorization required) (referral not required)
    Lab services:In-Network: $0 copay (authorization required) (referral not required)
    Lab services:Out-of-Network: $0 copay (authorization required) (referral not required)
    Outpatient x-rays:In-Network: $15 copay (authorization required) (referral not required)
    Outpatient x-rays:Out-of-Network: $20 copay (authorization required) (referral not required)

    Doctor visits

    Primary:In-Network: $0 copay
    Primary:Out-of-Network: $20-40 copay per visit
    Specialist:In-Network: $30 copay per visit (authorization required) (referral not required)
    Specialist:Out-of-Network: $40 copay per visit (authorization required) (referral not required)

    Emergency care/Urgent care

    Emergency: $90 copay per visit (always covered)
    Urgent care: $40 copay per visit (always covered)

    Foot care (podiatry services)

    Foot exams and treatment:In-Network: $0 copay (authorization required) (referral not required)
    Foot exams and treatment:Out-of-Network: $40 copay (authorization required) (referral not required)
    Routine foot care:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Routine foot care:Out-of-Network: $40 copay (limits may apply) (authorization required) (referral not required)

    Ground ambulance

    In-Network: $225 copay
    Out-of-Network: $225 copay

    Health plan deductible

    $0.00

    Health plan deductibles (other)

    In-Network: No

    Hearing

    Fitting/evaluation: Not covered (no limits)
    Hearing aids:In-Network: $175-1,225 copay (limits may apply) (authorization required) (referral not required)
    Hearing aids:Out-of-Network: $175-1,225 copay (limits may apply) (authorization required) (referral not required)
    Hearing exam:In-Network: $0 copay (authorization required) (referral not required)
    Hearing exam:Out-of-Network: $40 copay (authorization required) (referral not required)

    Hospital coverage (inpatient)

    In-Network: $230 per day for days 1 through 7
    $0 per day for days 8 through 90
    $0 per day for days 91 and beyond (authorization required) (referral not required)
    Out-of-Network: 40% per stay (authorization required) (referral not required)

    Hospital coverage (outpatient)

    In-Network: $0-230 copay per visit (authorization required) (referral not required)
    Out-of-Network: $330 copay per visit (authorization required) (referral not required)

    Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    $8,500 In and Out-of-network
    $4,400 In-network

    Medical equipment/supplies

    Diabetes supplies:In-Network: $0 copay (authorization required)
    Diabetes supplies:Out-of-Network: 20-50% coinsurance per item (authorization required)
    Durable medical equipment (e.g., wheelchairs, oxygen):In-Network: 20% coinsurance per item (authorization required)
    Durable medical equipment (e.g., wheelchairs, oxygen):Out-of-Network: 20-50% coinsurance per item (authorization required)
    Prosthetics (e.g., braces, artificial limbs):In-Network: 20% coinsurance per item (authorization required)
    Prosthetics (e.g., braces, artificial limbs):Out-of-Network: 20-50% coinsurance per item (authorization required)

    Medicare Part B drugs

    Chemotherapy:In-Network: 20% coinsurance (authorization required)
    Chemotherapy:Out-of-Network: 0-40% coinsurance (authorization required)
    Other Part B drugs:In-Network: 0-20% coinsurance (authorization required)
    Other Part B drugs:Out-of-Network: 0-40% coinsurance (authorization required)

    Mental health services

    Inpatient hospital – psychiatric:In-Network: $230 per day for days 1 through 7
    $0 per day for days 8 through 90 (authorization required) (referral not required)
    Inpatient hospital – psychiatric:Out-of-Network: 40% per stay (authorization required) (referral not required)
    Outpatient group therapy visit:In-Network: $15 copay (authorization required) (referral not required)
    Outpatient group therapy visit:Out-of-Network: $30-40 copay (authorization required) (referral not required)
    Outpatient group therapy visit with a psychiatrist:In-Network: $15 copay (authorization required) (referral not required)
    Outpatient group therapy visit with a psychiatrist:Out-of-Network: $30-40 copay (authorization required) (referral not required)
    Outpatient individual therapy visit:In-Network: $25 copay (authorization required) (referral not required)
    Outpatient individual therapy visit:Out-of-Network: $30-40 copay (authorization required) (referral not required)
    Outpatient individual therapy visit with a psychiatrist:In-Network: $25 copay (authorization required) (referral not required)
    Outpatient individual therapy visit with a psychiatrist:Out-of-Network: $30-40 copay (authorization required) (referral not required)

    Optional supplemental benefits

    No

    Preventive care

    In-Network: $0 copay (authorization not required) (referral not required)
    Out-of-Network: 0-40% coinsurance (authorization not required) (referral not required)

    Rehabilitation services

    Occupational therapy visit:In-Network: $20 copay (authorization required) (referral not required)
    Occupational therapy visit:Out-of-Network: $40 copay (authorization required) (referral not required)
    Physical therapy and speech and language therapy visit:In-Network: $20 copay (authorization required) (referral not required)
    Physical therapy and speech and language therapy visit:Out-of-Network: $40 copay (authorization required) (referral not required)

    Skilled Nursing Facility

    In-Network: $0 per day for days 1 through 20
    $196 per day for days 21 through 43
    $0 per day for days 44 through 100 (authorization required) (referral not required)
    Out-of-Network: $225 per day for days 1 through 38
    $0 per day for days 39 through 100 (authorization required) (referral not required)

    Transportation

    In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Out-of-Network: 75% coinsurance (limits may apply) (authorization not required) (referral not required)

    Vision

    Contact lenses:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Contact lenses:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Eyeglass frames: Not covered (no limits)
    Eyeglass lenses: Not covered (no limits)
    Eyeglasses (frames and lenses):In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Eyeglasses (frames and lenses):Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Other: Not covered (no limits)
    Routine eye exam:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Routine eye exam:Out-of-Network: $40 copay (limits may apply) (authorization required) (referral not required)
    Upgrades: Not covered

    Wellness programs (e.g., fitness, nursing hotline)

    Covered (authorization not required) (referral not required)

    Ready to sign up for UnitedHealthcare Chronic Complete (PPO C-SNP)?

    Get help from a licensed insurance agent.

    Call 1-877-354-4611 TTY 711.

    8am – 11pm EST. 7 days a week

    Table of Contents

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