UnitedHealthcare MedicareDirect Patriot (PFFS) H5435-001 is a 2023 Medicare Advantage Plan or Part-C by UnitedHealthcare available to residents in Wyoming and Nebraska. This plan does not provide extra prescription drug (Part-D) coverage. UnitedHealthcare UnitedHealthcare MedicareDirect Patriot (PFFS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $- (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $- out-of-pocket. This can be an extremely nice safety net.

UnitedHealthcare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for UnitedHealthcare MedicareDirect Patriot (PFFS) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from UnitedHealthcare and not Original Medicare. With 2023 Medicare Advantage Plan 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 if you sign up for Medicare Advantage in Wyoming or Medicare Advantage in Nebraska.

2023 UnitedHealthcare Medicare Advantage Plan Overview

What type of plan is UnitedHealthcare MedicareDirect Patriot (PFFS)

UnitedHealthcare MedicareDirect Patriot (PFFS) is a PFFS *. A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan offered by a contract with the Centers for Medicare & Medicaid Services (CMS) to provide you with benefits. UnitedHealthcare (instead of Medicare) will decide on how much it will cover and how much you will pay for the services you get. You may go to any Medicare approved doctor or hospital or any other health care provider that accepts both Medicare and your plans payment. A PFFS plan has no provider network, and you dont need a referral or a primary care physician for any health care or services. PFFS plans are the most flexible but a doctor will make a visit-by-visit decisions on whether to accept your provider.

How much does UnitedHealthcare MedicareDirect Patriot (PFFS) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. UnitedHealthcare charges a $0 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.

2023 Summary of Benefits

The benefit information provided is a summary of what UnitedHealthcare MedicareDirect Patriot (PFFS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from UnitedHealthcare helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

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

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Contact lenses

Vision	Not covered

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Eyeglass frames

Vision	Not covered

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Eyeglass lenses

Vision	Not covered

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Eyeglasses (frames and lenses)

Vision	Not covered

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Other

Vision	Not covered

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Routine eye exam

Vision	$0 copay

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Upgrades

Vision	Not covered

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Transportation	Not covered
Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 55 $0 per day for days 56 through 100

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Occupational therapy visit

Rehabilitation services	$40 copay

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Physical therapy and speech and language therapy visit

Rehabilitation services	$40 copay

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Cleaning

Preventive dental	Not covered

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Dental x-ray(s)

Preventive dental	Not covered

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Fluoride treatment

Preventive dental	Not covered

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Oral exam

Preventive dental	Not covered

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Preventive care	$0 copay
Outpatient hospital coverage	$0-395 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

Mental health services	$395 per day for days 1 through 4 $0 per day for days 5 through 90

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Outpatient group therapy visit

Mental health services	$15 copay

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Outpatient group therapy visit with a psychiatrist

Mental health services	$15 copay

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Outpatient individual therapy visit

Mental health services	$25 copay

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Outpatient individual therapy visit with a psychiatrist

Mental health services	$25 copay

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Chemotherapy

Medicare Part B drugs	20% coinsurance

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Other Part B drugs

Medicare Part B drugs	0-20% coinsurance

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Diabetes supplies

Medical equipment/supplies	$0 copay per item

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Durable medical equipment (e.g., wheelchairs, oxygen)

Medical equipment/supplies	20% coinsurance per item

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Prosthetics (e.g., braces, artificial limbs)

Medical equipment/supplies	20% coinsurance per item

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$6,700
Inpatient hospital coverage	$395 per day for days 1 through 4 $0 per day for days 5 through 90 $0 per day for days 91 and beyond

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Fitting/evaluation

Hearing	Not covered

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Hearing aids - inner ear

Hearing	Not covered

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Hearing aids - outer ear

Hearing	Not covered

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Hearing aids - over the ear

Hearing	Not covered

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Hearing exam

Hearing	$20 copay

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Health plan deductible	$0
Ground ambulance	$250 copay

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Foot exams and treatment

Foot care (podiatry services)	$50 copay

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Routine foot care

Foot care (podiatry services)	$50 copay

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Emergency

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

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Urgent care

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

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Primary

Doctor visits	$20 copay per visit

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Specialist

Doctor visits	$50 copay per visit

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Diagnostic radiology services (e.g., MRI)

Diagnostic procedures/lab services/imaging	$0-150 copay

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Diagnostic tests and procedures

Diagnostic procedures/lab services/imaging	$25 copay

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Lab services

Diagnostic procedures/lab services/imaging	$0 copay

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Outpatient x-rays

Diagnostic procedures/lab services/imaging	$15 copay

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Diagnostic services

Comprehensive dental	Not covered

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Endodontics

Comprehensive dental	Not covered

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Extractions

Comprehensive dental	Not covered

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Non-routine services

Comprehensive dental	Not covered

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Periodontics

Comprehensive dental	Not covered

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Prosthodontics, other oral/maxillofacial surgery, other services

Comprehensive dental	Not covered

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Restorative services

Comprehensive dental	Not covered

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

UnitedHealthcare MedicareDirect Patriot (PFFS) Reviews

Is UnitedHealthcare MedicareDirect Patriot (PFFS) a good plan? UnitedHealthcare MedicareDirect Patriot (PFFS) received a 3 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare UnitedHealthcare MedicareDirect Patriot Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H5435-001 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for UnitedHealthcare

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

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for UnitedHealthcare MedicareDirect Patriot (PFFS) requires you to live in that plan’s service area. The service area is listed below:

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Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.