Your plan details for
06752 Litchfield County

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UHC Medicare Advantage Patriot No Rx CT-MA01 (HMO-POS)

The information provided in this document may be subject to change over time and may become outdated. For the most current and up-to-date information, please refer to our website at UHC.com/medicare.

Discover the benefits

  • Medicare Part B premium giveback

    Up to $1,320 giveback a year on your Medicare Part B premium

  • OTC credit

    $125 credit every quarter for OTC products in-store or online

  • Routine vision benefits

    $200 allowance for eyewear every 2 years, plus $0 copay for a routine eye exam and lenses

Explore the plan details

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Explore the plan details

Doctor visits

Find out about this plan’s copays for primary care providers and specialists.

Primary care provider (PCP)

$0 copay
In-network

Specialist

$50 copay

(referral required)

In-network

Virtual visits

$0 copay

to talk with a network telehealth provider online through live audio and video.

Annual routine physical

$0 copay

1 per year

In-network

Preventive services (such as covered screenings, vaccinations, etc.)

$0 copay

for covered services

In-network

Group therapy visit

$15 copay
In-network

Individual therapy visit

$25 copay
In-network

Opioid treatment services

$0 copay
In-network

Medical benefit information

See this plan's benefits, costs and copays. For full plan details, see the Evidence of Coverage or Summary of Benefits under the Plan Documents section.

Inpatient hospital care

$455 copay

per day: days 1-6

$0 copay

per day: days 7 and beyond for unlimited days

In-network

Skilled nursing facility

$0 copay

per day: days 1-20

$218 copay

per day: days 21-100

In-network

Outpatient hospital services (including surgery and observation)

$455 copay
In-network

Ambulatory surgical center

$405 copay
In-network

Physical and speech therapy

$50 copay

(referral required)

In-network

Occupational therapy

$50 copay

(referral required)

In-network

Lab services

$0 copay
In-network

Outpatient X-rays

$30 copay
In-network

Diagnostic tests and procedures, non-radiological (such as EKG/ECG tests, etc.)

$55 copay
In-network

Diagnostic radiology services (such as MRIs, CT scans, etc.)

$260 copay
In-network

Diabetes monitoring supplies

$0 copay
In-network
Covered items include: Continuous glucose monitors (CGMs), blood glucose monitors, blood glucose test strips, lancet devices, lancets and glucose-control solutions for checking the accuracy of test strips and monitors (select brands only).

Home health care

$0 copay
In-network

Urgent care

$50 copay

per visit (

$0 copay

when outside of the United States)

Emergency care

$130 copay

per visit (

$0 copay

when outside of the United States)

Ambulance services

$290 copay

for ground or air

Dental coverage

Learn about this plan’s dental coverage options and costs.

Routine dental

$0 copay

for covered preventive services such as oral exams, routine cleanings, X-rays and fluoride


You will have access to one of Medicare Advantage's largest dental networks, or you can choose any dentist.

Optional rider

Add $44 to your monthly premium.


As a UnitedHealthcare member, you have the option to get dental coverage through the Platinum Dental Rider for an additional monthly fee. You will have access to one of Medicare Advantage's largest dental networks, or you can choose any dentist. Seeing a network dentist may save you money.

$1,500 per year for covered dental services through the Platinum Dental Rider.

$0 copay for covered network preventive services such as oral exams, routine cleanings, X-rays and fluoride

50% coinsurance for all comprehensive dental services, like crowns, fillings, extractions, bridges and dentures

Extra benefits and programs

See more of the benefits and programs offered by this plan that are not provided under Original Medicare.

See the UnitedHealthcare plan difference

Access to one of Medicare Advantage’s largest national networks of vision providers and retail providers. Eyewear available from many online providers, including Warby Parker and GlassesUSA.

Home-delivered eyewear available nationwide only through UnitedHealthcare Vision (select products only).

Routine eye exam

$0 copay

1 per year

In-network

Routine eyewear

$0 copay

for standard prescription lenses

$200 allowance

every 2 years for 1 pair of lenses/frames or contacts.

Hearing sounds better with more access

Choose from a broad selection of OTC and brand-name prescription hearing aids through UnitedHealthcare Hearing.

Access to one of the largest national networks with thousands of hearing professionals.

Routine hearing exam

$0 copay

1 per year

In-network

Hearing aids

$199 - $1,249 copay

per device, up to 2 hearing aids per year

Get more for your everyday needs

OTC credit

$125 credit

per quarter for OTC products like vitamins, pain relievers, first aid supplies and more in-store or online. Shop at thousands of participating stores, including Walmart, Walgreens and Dollar General, or at neighborhood stores near you.

$125 credit

per quarter for OTC products like vitamins, pain relievers, first aid supplies and more in-store or online. Shop at thousands of participating stores, including Walmart, Walgreens and Dollar General, or at neighborhood stores near you.

Rewards

Earn up to $150

in rewards every year for getting an annual wellness visit, being physically active, connecting with others and more.

Earn up to $150

in rewards every year for getting an annual wellness visit, being physically active, connecting with others and more.

Fitness program

$0 copay

for Renew Active®, which includes a free membership at core and premium gyms, plus online fitness classes and brain health challenges.

$0 copay

for Renew Active®, which includes a free membership at core and premium gyms, plus online fitness classes and brain health challenges.

Routine foot care

$45 copay

6 visits per year

In-network

Meal benefit

$0 copay

for 28 home-delivered meals immediately after an inpatient hospitalization or skilled nursing facility (SNF) stay.

Plan documents

Important documents that provide the details you need about this plan's coverage and benefits, prescription drugs, enrollment, providers and more.

Language

General Plan Information

Medical Providers

General Plan Information

Footnotes & disclaimers

footnote
Disclaimer information

 

Enrollment Disclaimer Information:

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. For Medicare Advantage and/or Prescription Drug Plans: A Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. For Dual Special Needs Plans: A Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan's contract renewal with Medicare.

 

AARP-related Disclaimer:

UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll in a Medicare Advantage or Prescription Drug Plan. AARP encourages you to consider your needs when selecting products and does not make specific product recommendations for individuals. AARP does not employ or endorse agents, producers or brokers.

 

Featured Benefits:

- Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

 

- Optum HouseCalls may not be available in all areas.

 

- OTC, food, and/or utility benefits have expiration timeframes. Review your Evidence of Coverage (EOC) for more information. The healthy food and utilities benefit is a special supplemental benefit only available to chronically ill enrolles with a qualifying condition, such as diabetes, cardiovascular disorders, chronic heart failure, chronic high blood pressure and/or chronic high cholesterol, and who also meet all applicable plan coverage criteria. There may be other qualified chronic conditions not listed.

 

- The Giveback benefit is a reduction in your Medicare Part B premium.

 

- A 50% coinsurance applies to covered dental comprehensive services. If your plan offers out-of-network dental coverage and you see an out-of-network dentist, you might be billed more. Network size varies by local market.

 

- Reward offerings may vary by plan. Reward program Terms of Service apply.

 

- If your plan offers out-of-network dental coverage and you see an out-of-network dentist, you might be billed more. Network size varies by local market.

 

- Routine transportation not for use in emergencies. A trip is one-way and roundtrip is two trips.

 

- Annual routine eye exam and an allowance for contacts or one pair of frames, with standard (single, bi-focal, tri-focal or standard progressive) lenses covered in full every one or two years. Review your Evidence of Coverage (EOC) for more information.

 

- CareFlex benefit credits can only be used by members of AARP Medicare Advantage CareFlex plans for cost-shares for certain Medicare Parts A and B covered items and services. CareFlex credits are loaded on a Visa debit card. Unused credits will rollover each quarter and expire Dec. 31. Credits not redeemable for cash.

 

- The fitness benefit and gym network varies by plan/area and participating locations may change. The fitness benefit includes a standard fitness membership at participating locations. Not all plans offer access to premium locations. Consult your doctor prior to beginning an exercise program or making changes to your lifestyle or health care routine.

 

- The plan only covers hearing aids from a UnitedHealthcare Hearing network provider. Other hearing exam providers are available in the UnitedHealthcare network.

 

Other Languages:

This information is available for free in other languages. Please contact Customer Service for additional information. 

 

Esta información está disponible sin costo en otros idiomas. Para obtener más información comuníquese con nuestro Servicio al Cliente. 

 

本資訊可以其他語言免費提供。如需更多資訊，請聯絡客戶服務部。 

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