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UHC Complete Care TX-29 (Regional PPO C-SNP)

UnitedHealthcare
UHC Complete Care TX-29 (Regional PPO C-SNP) R6801-009 Plan Details
3 out of 5 stars

UHC Complete Care TX-29 (Regional PPO C-SNP) is a Regional PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: R6801-009

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$22.00
Monthly Premium

UHC Complete Care TX-29 (Regional PPO C-SNP) is a Regional PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: R6801-009

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

UnitedHealthcare
UHC Complete Care TX-29 (Regional PPO C-SNP) R6801-009 Plan Details
3 out of 5 stars

UHC Complete Care TX-29 (Regional PPO C-SNP) is a Regional PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: R6801-009

HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$22.00
Monthly Premium

Texas Counties Served

El Paso Hardin Jackson Yoakum Austin Matagorda Wharton Galveston Washington Jefferson Travis Orange Frio Dawson Taylor Live Oak Lavaca Sherman Bexar Culberson Jones Comal Stonewall Blanco Collin Dallas Denton Rockwall Tarrant Guadalupe Hays San Patricio Upton Freestone Newton Walker Clay Johnson Polk Bastrop Caldwell Kinney Moore Runnels Knox Cooke Haskell Archer Bell Baylor Eastland Stephens Comanche Brown Hall Lampasas Callahan Coleman Falls Deaf Smith Williamson Hansford Milam Hutchinson Coryell Oldham Mclennan Burnet Burleson Llano Lee Hartley Dallam Concho Schleicher Menard Sutton Kerr Tom Green Edwards Reagan Carson Roberts King Harris Fort Bend Montgomery Motley Cottle San Jacinto Liberty Chambers Waller Hudspeth Gillespie Mills Mason San Saba Kendall Dona Ana Atascosa Medina Bandera Wilson Brazoria Hidalgo Grayson Van Zandt Ellis Kaufman Hunt Fannin Montague Parker Wise Somervell Hood Bosque Palo Pinto Jack Erath Hamilton La Salle Mcmullen Real Karnes Gonzales Nacogdoches Angelina Tyler Jasper Colorado Crosby Lubbock Calhoun Hockley Scurry Brazos Webb Terry Victoria Goliad Refugio De Witt Garza Martin Borden Lynn Kent Glasscock Zapata Howard Smith Bee Nolan Navarro Red River Sabine Fisher Andrews Henderson Anderson Nueces Lamar Jim Wells Delta Duval Kenedy Rains Wood Hopkins Upshur Camp Cherokee Morris Gregg Titus Franklin Aransas Midland Bowie Cass Marion Harrison Rusk Brooks Panola Kleberg Shelby Leon Limestone Jim Hogg Reeves Trinity San Augustine Pecos Houston Cameron Madison Starr Willacy Uvalde Ward Hill Irion Dimmit Maverick Ochiltree Throckmorton Wilbarger Wichita Zavala Young Terrell Crane Foard Shackelford Fayette Lipscomb Gray Parmer Swisher Dickens Jeff Davis Wheeler Hemphill Ector Hardeman Potter Robertson Randall Donley Hale Lamb Armstrong Mcculloch Briscoe Castro Kimble Bailey Val Verde Floyd Gaines Crockett Coke Collingsworth Loving Mitchell Winkler Brewster Sterling Cochran Childress Presidio Grimes

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $495
Out of Pocket Max In-Network: $7500
Out-of-Network: N/A
Initial Coverage Limit $2000
Catastrophic Coverage Limit $2,000
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0 to $5
Note: $0 copayment applies to Medicare covered telehealth and Medicare covered remote monitoring. The higher cost share applies to all other Medicare covered services.
Specialty Doctor Visit
In Network
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $0 to $45
Prior Authorization Required for Doctor Specialty Visit
Note: $0 copayment applies to Medicare covered telehealth and Medicare covered remote monitoring. The higher cost share applies to all other Medicare covered services.


Out of Network

Out-of-Network:

Doctor Specialty Visit Services:
Copayment for Medicare Covered Physician Specialist Office Visit $45
Note: $0 copayment applies to Medicare covered telehealth and Medicare covered remote monitoring. The higher cost share applies to all other Medicare covered services.
Prior authorization required
Inpatient Hospital Care
In Network
In-Network:

Acute Hospital Services:
$325 per day for days 1 to 7
$0 per day for days 8 to 90
Prior Authorization Required for Acute Hospital Services
Note: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b.


Out of Network

Out-of-Network:

Acute Hospital Services:
$325 per day for days 1 to 7
$0 per day for days 8 to 999
Note: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b.
Prior authorization required
Urgent Care
Copayment for Urgent Care $0 to $45

Note: $0 copayment applies to Medicare covered telehealth. The higher cost share applies to all other Medicare covered services.

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $0
Emergency Room Visit
Copayment for Emergency Care $110
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $0
Copayment for Worldwide Emergency Transportation $0
Ambulance Transportation
In Network
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $290

Air Ambulance:
Copayment for Air Ambulance Services $290
Prior Authorization Required for Air Ambulance


Out of Network

Out-of-Network:

Ambulance Services:
Copayment for Medicare Covered Ambulance Services - Ground $290
Copayment for Medicare Covered Ambulance Services - Air $290
Prior authorization required

Health Care Services and Medical Supplies

UHC Complete Care TX-29 (Regional PPO C-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In Network
In-Network:
Copayment for Medicare-covered Chiropractic Services $15
Prior Authorization Required for Chiropractic Services


Out of Network

Out-of-Network:

Medicare Covered Chiropractic Services:
Copayment for Medicare Covered Chiropractic Services $15
Prior authorization required
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In Network
In-Network:
Copayment for Medicare-covered Diabetic Supplies $0
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0


Out of Network

Out-of-Network:

Medicare Covered Diabetic Supplies and Services:
Coinsurance for Medicare Covered Diabetic Supplies 50%
Coinsurance for Medicare Covered Diabetic Therapeutic Shoes or Inserts 50%
Durable Medical Eqipment (DME)
In Network
In-Network:
Coinsurance for Medicare-covered Durable Medical Equipment 20%
Prior Authorization Required for Durable Medical Equipment


Out of Network

Out-of-Network:

Medicare Covered Durable Medical Equipment Services:
Coinsurance for Medicare Covered Durable Medical Equipment 50%
Prior authorization required
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Diagnostic Tests and Procedures:
$60 copay

Lab Services:
$0 copay

Diagnostic Radiology Services:
$250 copay

X-rays:
$35 copay
Home Health Care
In Network
In-Network:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services


Out of Network

Out-of-Network:

Medicare Covered Home Health Services:
Coinsurance for Medicare Covered Home Health 50%
Prior authorization required
Mental Health Inpatient Care
In Network
In-Network:

Psychiatric Hospital Services:
$325 per day for days 1 to 5
$0 per day for days 6 to 90
Prior Authorization Required for Psychiatric Hospital Services
Benefit Details - General Note - NOTE ON INPATIENT SUBSTANCE ABUSE: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b.


Out of Network

Out-of-Network:

Psychiatric Hospital Services:
$325 per day for days 1 to 5
$0 per day for days 6 to 90
Benefit Details - General Note - NOTE ON INPATIENT SUBSTANCE ABUSE: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b.
Prior authorization required
Mental Health Outpatient Care
In Network
In-Network:
Copayment for Medicare-covered Individual Sessions $0 to $25
Copayment for Medicare-covered Group Sessions $15


Out of Network

Out-of-Network:

Medicare Covered Mental Health Services:
Copayment for Medicare Covered Individual Sessions $25
Copayment for Medicare Covered Group Sessions $15
Outpatient Services / Surgery
In Network
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0 to $325
Prior Authorization Required for Outpatient Hospital Services
Note: $0 copayment for outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures.Note: Benefit category includes both the facility and professional component.

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per day $325
Prior Authorization Required for Outpatient Observation Services
Benefit Details - General 9a2 Note - NOTE ON OBSERVATION SERVICES: Benefit category includes both the facility and professional component.

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0 to $325
Prior Authorization Required for Ambulatory Surgical Center Services
Benefit Details - General 9b Note - NOTE ON ASC SERVICES: Benefit category 9b includes both the facility and professional component.Benefit Details - General 9b Note - NOTE ON COST SHARING RANGE FOR ASC Services: $0 copayment for outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures.


Out of Network

Out-of-Network:

Medicare Covered Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0 to $325
Copayment for Medicare Covered Ambulatory Surgical Center Services $0 to $325
Note: $0 copayment for outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures.Note: Benefit category includes both the facility and professional component.
Prior authorization required
Outpatient Substance Abuse Care
In Network
In-Network:
Copayment for Medicare-covered Individual Sessions $0 to $25
Copayment for Medicare-covered Group Sessions $15
Prior Authorization Required for Outpatient Substance Abuse Services
Note: $0 copayment applies to Medicare covered telehealth for individual sessions. The higher cost share applies to all other Medicare covered services.


Out of Network

Out-of-Network:

Medicare Covered Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual Sessions $25
Copayment for Medicare Covered Group Sessions $15
Note: $0 copayment applies to Medicare covered telehealth for individual sessions. The higher cost share applies to all other Medicare covered services.
Prior authorization required
Over-the-counter (OTC) Items
OTC credit:
$25 credit per quarter to buy covered OTC products.
Podiatry Services
In Network
In-Network:
Copayment for Medicare-Covered Podiatry Services $0
Copayment for Routine Foot Care $0
  • Maximum 6 visits every year
Prior Authorization Required for Podiatry Services


Out of Network

Out-of-Network:

Medicare Covered Podiatry Services:
Copayment for Medicare Covered Podiatry Services $0

Non-Medicare Covered Podiatry Services:
Copayment for Non-Medicare Covered Podiatry Services $0
Prior authorization required
Skilled Nursing Facility Care
In Network
In-Network:

Skilled Nursing Facility Services:
$0 per day for days 1 to 20
$203 per day for days 21 to 100
Prior Authorization Required for Skilled Nursing Facility Services


Out of Network

Out-of-Network:

Skilled Nursing Facility Services:
$0 per day for days 1 to 20
$203 per day for days 21 to 100
Prior authorization required

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In Network
In-Network:

Preventive Dental:
Coinsurance for Office Visit 20%
Prior Authorization Required for Preventive Dental


Out of Network

Out-of-Network:

Medicare Covered Preventive Dental Services:
Coinsurance for Medicare Covered Preventive Dental 20%
Prior authorization required

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
Routine Eye Exam:
$0 copay, 1 per year

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In Network
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $0
Copayment for Routine Hearing Exams $0
  • Maximum 1 visit every year
Prior Authorization Required for Hearing Exams

Hearing Aids:
Copayment for Hearing Aids $199 to $1249
  • Maximum 2 Hearing Aids every year


Out of Network

Out-of-Network:

Medicare Covered Hearing Exams Services:
Copayment for Medicare Covered Hearing Exams $45
Prior authorization required

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In Network
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
    • Tobacco use cessation
    Yearly "Wellness" visit



    Out of Network

    Out-of-Network:

    Medicare Covered Medicare-covered Preventive Services:
    Copayment for Medicare Covered Medicare-covered Preventive Services $0

    Prescription Drug Costs and Coverage

    The UHC Complete Care TX-29 (Regional PPO C-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $495 (excludes Tiers 1 and 2) per year.

    Coverage
    Cost
    Coverage & Cost
    Annual Drug Deductible $495 (excludes Tiers 1 and 2)
    Preferred Generic
    • Standard retail $4.00
    • Preferred cost-share mail order N/A
    • Standard mail order N/A
    Generic
    • Standard retail $14.00
    • Preferred cost-share mail order N/A
    • Standard mail order N/A
    Annual Drug Deductible $495 (excludes Tiers 1 and 2)
    Preferred Generic
    • Standard retail N/A
    • Preferred cost-share mail order N/A
    • Standard mail order N/A
    Generic
    • Standard retail N/A
    • Preferred cost-share mail order N/A
    • Standard mail order N/A
    Annual Drug Deductible $495 (excludes Tiers 1 and 2)
    Preferred Generic
    • Standard retail $12.00
    • Preferred cost-share mail order $0.00
    • Standard mail order $12.00
    Generic
    • Standard retail $42.00
    • Preferred cost-share mail order $0.00
    • Standard mail order $42.00
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