Page 66 - Evaluation for 2018

1/3/2018 Your Medicare Health Plan Details

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Your Plan Details

Zip Code: 99005
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: 1321108544
and more coverage and star ratings.
Password Date: 12/23/2017
Important Coverage Information

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

Preventive care $0 copay

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