Page 70 - Cover Letter and Evaluation for Amy Prack
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Your Plan Details
Zip Code: 43221
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits, drug costs Drug List ID: 3233662560
and more coverage and star ratings.
Password Date: 05/12/2019
Important Coverage Information
Symbols
Some Dental Coverage Some Vision Coverage Some Hearing Coverage
* Estimated
AARP MedicareComplete 3315 Central AVE Overall Star Rating: Enroll
Plan 2 (HMO) Hot Springs, AR 71913 [?]
Members: 1-800-643-4845 711
(H5253-053-0) (TTY/TDD) Non Members: 4 out of 5 stars
1-800-555-5757 711 (TTY/TDD)
Organization: UnitedHealthcare
Plan Type: HMO
Benefits Highlights
Monthly health plan premium $5.80
Health plan deductible $0
Other health plan deductibles?
In-Network: No
Maximum out-of-pocket enrollee $4,500 In-network
responsibility (does not include
prescription drugs)
Optional supplemental benefits [?] No
Additional benefits and/or reduced cost-
sharing for enrollees with certain health In-Network: No
conditions?
Inpatient hospital coverage $325 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
Outpatient hospital coverage $295 per visit
Doctor visits Primary: $5 per visit
Specialist: $35 per visit
