2022 Erickson Advantage Liberty without Drugs (HMO-POS)

Erickson Advantage Liberty without Drugs (HMO-POS) H5652-002 is a 2022 Medicare Advantage Plan or Part-C by UnitedHealthcare available to residents in Maryland and Pennsylvania. This plan does not provide additional prescription drug (Part-D) coverage. The Erickson Advantage Liberty without Drugs (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out-of-pocket. This can be a extremely nice safety net.

Erickson Advantage Liberty without Drugs (HMO-POS) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.

UnitedHealthcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Erickson Advantage Liberty without Drugs (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from UnitedHealthcare and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from UnitedHealthcare except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 UnitedHealthcare Medicare Advantage Plan Costs

2021 Erickson Advantage Liberty without Drugs (HMO-POS) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	Not covered

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Deductible

$800 In-network

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$0-100 copay
Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0 copay
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Lab services	$0 copay (Out-of-Network)
Lab services	$0 copay
Outpatient x-rays	$20 copay (Out-of-Network)
Outpatient x-rays	$15 copay

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Doctor Visits

Primary	30% coinsurance per visit (Out-of-Network)
Primary	$20-30 copay per visit
Specialist	$50 copay per visit
Specialist	30% coinsurance per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$30 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	30% coinsurance (Out-of-Network)
Foot exams and treatment	$50 copay
Routine foot care	30% coinsurance (Out-of-Network)
Routine foot care	$50 copay

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Ground Ambulance

$250 copay
$250 copay (Out-of-Network)

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Hearing

Fitting/evaluation	Not covered
Hearing aids	$375 copay (Out-of-Network)
Hearing aids	$375-2,075 copay
Hearing exam	30% coinsurance (Out-of-Network)
Hearing exam	$0 copay

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Inpatient Hospital Coverage

$300 per day for days 1 through 7 $0 per day for days 8 through 90 $0 per day for days 91 and beyond
30% per stay (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	30% coinsurance per item (Out-of-Network)
Diabetes supplies	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	30% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	30% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance
Other Part B drugs	30% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	30% per stay (Out-of-Network)
Inpatient hospital - psychiatric	$300 per day for days 1 through 5 $0 per day for days 6 through 90
Outpatient group therapy visit	30% coinsurance (Out-of-Network)
Outpatient group therapy visit	$0 copay
Outpatient group therapy visit with a psychiatrist	$30 copay
Outpatient group therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$0-30 copay
Outpatient individual therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$30 copay

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MOOP

$6,700 In-network

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Option

No

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Optional supplemental benefits

Yes

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Outpatient Hospital Coverage

$0-300 copay per visit
30% coinsurance per visit (Out-of-Network)

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Package #1

Deductible
Monthly Premium	$40.00

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Preventive Care

$0 copay
0-30% coinsurance (Out-of-Network)

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Preventive Dental

Cleaning	$0 copay
Cleaning	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	$0 copay (Out-of-Network)
Fluoride treatment	$0 copay
Oral exam	$0 copay (Out-of-Network)
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	30% coinsurance (Out-of-Network)
Occupational therapy visit	$40 copay
Physical therapy and speech and language therapy visit	$40 copay
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)

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Skilled Nursing Facility

$0 per day for days 1 through 20 $184 per day for days 21 through 57 $0 per day for days 58 through 100
30% per stay (Out-of-Network)

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Transportation

$0 copay

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Vision

Contact lenses	$0 copay (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	30% coinsurance (Out-of-Network)
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Erickson Advantage Liberty without Drugs (HMO-POS) H5652

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Erickson Advantage Liberty without Drugs (HMO-POS) Plans Performance

Health Plan Customer Service Rating for Erickson Advantage Liberty without Drugs (HMO-POS)

Erickson Advantage Liberty without Drugs (HMO-POS) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Erickson Advantage Liberty without Drugs (HMO-POS)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.