2022 UnitedHealthcare Medicare Advantage Choice (PPO)

UnitedHealthcare Medicare Advantage Choice (PPO) H2577-020 is a 2022 Medicare Advantage Plan or Part-C by UnitedHealthcare available to residents in Tennessee and Virginia. This plan includes additional prescription drug (Part-D) coverage. The UnitedHealthcare Medicare Advantage Choice (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,900 out-of-pocket. This can be a extremely nice safety net.

UnitedHealthcare Medicare Advantage Choice (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

UnitedHealthcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for UnitedHealthcare Medicare Advantage Choice (PPO) 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

UnitedHealthcare Medicare Advantage Choice (PPO) Part-C Premium

UnitedHealthcare charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H2577-020 Part-D Deductible and Premium

UnitedHealthcare Medicare Advantage Choice (PPO) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This UnitedHealthcare plan offers a $0.00 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by UnitedHealthcare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

UnitedHealthcare Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This UnitedHealthcare plan does offer additional coverage through the gap.

H2577-020 Formulary or Drug Coverage

UnitedHealthcare Medicare Advantage Choice (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 UnitedHealthcare Medicare Advantage Choice (PPO) H2577-020 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$0
Tier 2	NA	$8
Tier 3	NA	$45
Tier 4	NA	$95
Tier 5	NA	33%

*Initial Coverage Phase and 30 day supply

2021 UnitedHealthcare Medicare Advantage Choice (PPO) 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	$0 copay (Out-of-Network)
Diagnostic services	$0 copay
Endodontics	$0 copay (Out-of-Network)
Endodontics	$0 copay
Extractions	$0 copay (Out-of-Network)
Extractions	$0 copay
Non-routine services	$0 copay
Non-routine services	$0 copay (Out-of-Network)
Periodontics	$0 copay
Periodontics	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (Out-of-Network)
Restorative services	$0 copay
Restorative services	$0 copay (Out-of-Network)

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$0-110 copay
Diagnostic radiology services (e.g., MRI)	$150-200 copay (Out-of-Network)
Diagnostic tests and procedures	$20 copay
Diagnostic tests and procedures	$40 copay (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	$0 copay
Primary	$20 copay per visit (Out-of-Network)
Specialist	$50 copay per visit (Out-of-Network)
Specialist	$35 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$30-40 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$35 copay
Foot exams and treatment	$50 copay (Out-of-Network)
Routine foot care	$35 copay
Routine foot care	$50 copay (Out-of-Network)

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Ground Ambulance

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

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Hearing

Fitting/evaluation	Not covered
Hearing aids	$375-2,075 copay
Hearing aids	$375 copay (Out-of-Network)
Hearing exam	$0 copay
Hearing exam	$50 copay (Out-of-Network)

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Inpatient Hospital Coverage

$295 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 and beyond
$495 per day for days 1 through 20 $0 per day for days 21 and beyond (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	$0 copay per item
Diabetes supplies	40% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20-50% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	40% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	40% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	40% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$495 per day for days 1 through 20 $0 per day for days 21 through 90 (Out-of-Network)
Inpatient hospital - psychiatric	$295 per day for days 1 through 5 $0 per day for days 6 through 90
Outpatient group therapy visit	$30-40 copay (Out-of-Network)
Outpatient group therapy visit	$15 copay
Outpatient group therapy visit with a psychiatrist	$15 copay
Outpatient group therapy visit with a psychiatrist	$30-40 copay (Out-of-Network)
Outpatient individual therapy visit	$25 copay
Outpatient individual therapy visit	$30-40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$30-40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$25 copay

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MOOP

$10,000 In and Out-of-network $5,900 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$0-250 copay per visit
$495 copay per visit (Out-of-Network)

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Preventive Care

0-40% coinsurance (Out-of-Network)
$0 copay

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Preventive Dental

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

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Rehabilitation Services

Occupational therapy visit	$50 copay (Out-of-Network)
Occupational therapy visit	$35 copay
Physical therapy and speech and language therapy visit	$50 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$35 copay

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Skilled Nursing Facility

$225 per day for days 1 through 45 $0 per day for days 46 through 100 (Out-of-Network)
$0 per day for days 1 through 20 $184 per day for days 21 through 53 $0 per day for days 54 through 100

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Transportation

Not covered

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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
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	$50 copay (Out-of-Network)
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for UnitedHealthcare Medicare Advantage Choice (PPO) H2577

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in UnitedHealthcare Medicare Advantage Choice (PPO) Plans Performance

Health Plan Customer Service Rating for UnitedHealthcare Medicare Advantage Choice (PPO)

UnitedHealthcare Medicare Advantage Choice (PPO) 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 UnitedHealthcare Medicare Advantage Choice (PPO)

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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.