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UnitedHealthcare Community Plan
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    1-855-611-3989
    TTY:711 , 8 a.m. – 8 p.m. local time, 7 days a week
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UnitedHealthcare Dual Complete™ RP (Regional PPO SNP)

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This is a Medicare Advantage plan for people on Medicaid who also qualify for Medicare – commonly known as "dual eligible." It's intended for people who live in a community setting, receive financial help (such as SSI) from their State Medicaid program and have Medicare. This plan includes all Medicare Part A (Hospital) & B (Doctor) benefits and Part D prescription drug coverage. It also provides benefits not offered by Original Medicare.

This plan is available in the following counties: This plan is available statewide.

Call us at 1-855-611-3989 or let us call you
TTY: 711
8 a.m. – 8 p.m. local time, 7 days a week

Monthly Premium1*

Drug Copays or Coinsurance*

Medical Copays, Coinsurance or Deductible*

Out-of-Pocket Maximum*
$0.00 25% for Tier 1
25% for Tier 2
25% for Tier 3
25% for Tier 4
25% for Tier 5
Office Visits
$0.00 for primary care physicians
20% for specialists

Inpatient Hospital Visits
$1188.00 per stay
In-network
$6700
*Your costs may be as low as $0, depending on your level of Medicaid eligibility. Please call 1-800-905-8671 TTY: 711 8 a.m. – 8 p.m. local time, 7 days a week for more information on your costs with this plan.
Medicare Plan Rating

Medicare Plan Rating (PDF 108.68 KB)

Benefits

View Summary of Benefits (PDF 334.77 KB)

Download the Enrollment Application (PDF 165.22 KB) or the Enrollment Application (Español) (PDF 171.83 KB)

Disclaimer Information

1Amount shown does not include Medicare Part B premium, which you must continue to pay if not otherwise paid for under Medicaid or by another third party. Beneficiaries who qualify for extra help may pay a lower monthly plan premium. For more information, see Paying for Medicare.

2Numbers shown in this table reflect in-network copayments. Depending on the type of plan you choose, if you obtain care from out-of-network providers, those services may not be covered by the plan or you may have to pay higher copayments/coinsurance than shown here. See a plan's Evidence of Coverage for specific copayments or coinsurance.

3Amounts may vary depending on the level of care provided or the type of health care services you receive.

UnitedHealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Enrollment in the plan depends on the plan’s contract renewal with Medicare.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply.

Benefits, formulary, pharmacy network, provider network, premium and/or copays may change on January 1 of each year. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party. Premiums and copays may vary based on the level of Extra Help you receive. Please contact the plan for further details.

UnitedHealthcare Senior Care Options (HMO SNP) Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Medicare. Enrollment in the plan depends on the plan’s contract renewal with Medicare.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply.

Benefits, formulary, pharmacy network, provider network, premium and/or copays may change on January 1 of each year. Premiums and copays may vary based on the level of Extra Help you receive. Please contact the plan for further details. Enrollees have no out of pocket costs.

Availability of Non-English Disclaimer

This information is available for free in other languages. Please call our customer service number at 1-800-905-8671, TTY 711, 8 a.m. - 8 p.m. local time, 7 days a week.

Esta información está disponible sin costo en otros idiomas. Comuníquese con nuestro Servicio al Cliente al número 1-800-905-8671, TTY 711, de 8 a.m. – 8 p.m. hora local, los 7 días de la semana.

Star Ratings Disclaimer 
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

Formularies on Plan Sponsor Websites

This drug may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.

UnitedHealthcare Dual Complete covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

This is not a complete list of all formulary alternatives covered by the Part D plan for the drug you have selected.