Page 76 - Cover Letter and Evaluation for Debbie Workman

12/13/2017 Your Medicare Health Plan Details

Return to previous page
Your Plan Details

Zip Code: 99206
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: 2065979904
and more coverage and star ratings.
Password Date: 12/13/2017
Important Coverage Information

You are now viewing 2018 plan data. View 2017 plan data.
Symbols

Some Vision Coverage Some Hearing Coverage
* Estimated

AARP MedicareComplete 3315 Central AVE Overall Star Rating: [?] Enroll
Hot Springs, AR 71913
Plan 1 (HMO)
(H1286-002-0) Members: 4 out of 5 stars

1-800-643-4845
Organization: UnitedHealthcare 711 (TTY/TDD)
Plan Type: Non Members:
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 $5,500 In-network
responsibility (does not include
prescription drugs)
Optional supplemental benefits [?] No

Inpatient hospital coverage $395 for days 1 through 4
$0 for days 5 through 90
$0 for days 91 and beyond

Outpatient hospital coverage 20% per visit

Doctor visits Primary: $10 per visit
Specialist: $45 per visit

https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=H1286&plnid=002&sgmntid=0 1/4