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07702 Monmouth County

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UHC Dual Complete NJ-Y001 (HMO D-SNP)

The information provided in this document may be subject to change over time and may become outdated.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.

  • Monthly premium

    new former $0

  • $0
    In-network
  • $0
    In-network
  • $0 copay
    In-network
  • Covered for urgent and emergency care only
  • Estimated annual drug cost

Discover the benefits

  • OTC, food and utilities

    $246 credit every month for OTC, plus healthy food and utilities for qualifying members
  • Fitness benefit

    Free gym membership at core and premium locations
  • No cost medical services

    $0 copay for primary care, hospital stays and specialist visits

Explore the plan details

Jump To:

Explore the plan details

Eligibility

Special eligibility requirement

For those who have full Medicaid benefits. After joining this plan, you'll also be enrolled in NJ FamilyCare for a combined Medicare and Medicaid experience: NJ: FBDE, QMB PLUS

Doctor visits

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

Primary care provider (PCP)

$0 copay
In-network

Specialist

$0 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

$0 copay
In-network

Individual therapy visit

$0 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

$0 per stay for unlimited days
In-network

Skilled nursing facility

$0 copay per day: days 1-100
In-network

Outpatient hospital services (including surgery and observation)

$0 copay
In-network

Ambulatory surgical center

$0 copay
In-network

Physical and speech therapy

$0 copay (referral required)
In-network

Occupational therapy

$0 copay (referral required)
In-network

Lab services

$0 copay
In-network

Outpatient X-rays

$0 copay
In-network

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

$0 copay
In-network

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

$0 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). Insulin and syringes are covered under your Part D prescription drug benefit.

Home health care

$0 copay
In-network

Urgent care

$0 copay per visit ($0 copay when outside of the United States)

Emergency care

$0 copay per visit ($0 copay when outside of the United States)

Ambulance services

$0 copay for ground or air

Prescription drug benefits

Learn about this plan's costs for prescription drug coverage.

Annual prescription deductible

$0 if you qualify for Extra Help

Cost shares if you receive Extra Help

Brand Drugs

$0 copay

Generic Drugs

$0 copay

Cost shares if you receive Extra Help

Brand Drugs

$0

Generic Drugs

$0

Cost shares if you receive Extra Help

Brand Drugs

$0

Generic Drugs

$0

Cost shares if you receive Extra Help

Brand Drugs

$0

Generic Drugs

$0

Dental coverage

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

Routine dental

For more details on Medicaid coverage, see the Summary of Benefits under the Plan Documents section


Extra benefits and programs

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

Get more for your everyday needs

OTC, healthy food, utilities + wellness support

$246 credit per month for OTC products and wellness support, plus healthy food and utilities for members with a qualifying condition such as diabetes, cardiovascular disorders, chronic heart failure, chronic high blood pressure and/or chronic high cholesterol. Buy first aid supplies, pain relievers, fruits, meat and more or pay home utilities like electricity or internet. Get wellness support including in-home services, select fitness items and more.

Rewards

Earn up to $165 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.

Routine transportation

For more details on Medicaid coverage, see the Summary of Benefits under the Plan Documents section

Meal benefit

$0 copay for 28 home-delivered meals immediately after an inpatient hospitalization or skilled nursing facility (SNF) stay.

Routine eye exam

For more details on Medicaid coverage, see the Summary of Benefits under the Plan Documents section

Routine eyewear

For more details on Medicaid coverage, see the Summary of Benefits under the Plan Documents section

Routine hearing exam

Not covered
In-network

Hearing aids

For more details on Medicaid coverage, see the Summary of Benefits under the Plan Documents section

Plan documents

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

Language

Medical Providers

Online Medical and Behavioral Health Directory Opens in a new window

General Plan Information

Prescription Drug Coverage

Pharmacy Directory

Online Pharmacy Directory Opens in a new tab

Medical Providers

General Plan Information

Prescription Drug Coverage

Pharmacy Directory

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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.

 

Extra Help: 

If you are receiving Extra Help from Medicare, your copays may be lower or you may have no copays. 

 

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.

 

Out-of-network:

Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 

 

The Medicare Prescription Payment Plan: 

If you have high out-of-pocket costs for your covered Part D prescription drugs each year, you may want to participate in the Medicare Prescription Payment Plan. This payment plan spreads your out-of-pocket prescription drug costs over the remainder of the calendar year. Learn more about the Medicare Prescription Payment Plan.
 

Out-of-network:

Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 

 

State-Level Medicaid, D-SNP Disclaimer:

D-SNP and C-SNP: The values shown in-network represent a range based upon the amount of the Medicare Parts A and B plan cost sharing covered by the state. Depending on your Medicaid eligibility, your Medicaid program may have cost sharing. For complete information, and for costs for those without Medicare Parts A and B plan cost sharing covered by the state, and applicable Medicaid cost sharing, please refer to your Summary of Benefits or Evidence of Coverage. Limitations, exclusions, and restrictions may apply.

 

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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