Page 85 - Cover Letter & Evaluation for Michael Novotny
P. 85
6/9/2018 Your Medicare Health Plan Details
Return to previous page
Your Plan Details
Zip Code: 92886
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits,
drug costs and more coverage and star ratings. Important Coverage Information
Symbols
A process through which the enrollee’s primary care physician or other network physician (depending on the plan
policy) permits or instructs the enrollee to obtain an item or service from another physician or other provider type.
Some Dental Coverage Some Vision Coverage Some Hearing Coverage
* Estimated
AARP MedicareComplete 3315 Central AVE Overall Star Rating: [?] Enroll
SecureHorizons Plan 1 Hot Springs, AR 71913
(HMO) Members: 4.5 out of 5 stars
(H0543-004-0) 1-800-950-9355
711 (TTY/TDD)
Organization: UnitedHealthcare
Non Members:
Plan Type: HMO 1-800-555-5757
711 (TTY/TDD)
Benefits Highlights
Monthly health plan premium $0.00
Health plan deductible $0
Other health plan deductibles?
In-Network: No
Maximum out-of-pocket enrollee $4,900 In-network
responsibility (does not include
prescription drugs)
Optional supplemental benefits [?] Yes
Inpatient hospital coverage $150 for days 1 through 5
$0 for days 6 through 90
$0 for days 91 and beyond
Outpatient hospital coverage $125 per visit
Doctor visits Primary: $5 per visit
Specialist: $10 per visit
https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=H0543&plnid=004&sgmntid=0 1/4
