AARP Medicare Advantage Walgreens (HMO)
H3805 - 030 - 0
(4.5 / 5)
AARP Medicare Advantage Walgreens (HMO) is a Medicare Advantage (Part C) Plan by UnitedHealthcare.
This page features plan details for 2022 AARP Medicare Advantage Walgreens (HMO) H3805 – 030 – 0 available in Clark county.
IMPORTANT: This page features the 2022 version of this plan. See the 2024 version using the link below:
No 2024 version found. You can use the location links below to find 2024 plans in your area.
Locations
AARP Medicare Advantage Walgreens (HMO) is offered in the following locations.
Plan Overview
AARP Medicare Advantage Walgreens (HMO) offers the following coverage and cost-sharing.
| Insurer: | UnitedHealthcare |
| Health Plan Deductible: | $0 |
| MOOP: | $5,900.00 |
| Drugs Covered: | Yes |
Please Note:
- This plan does not charge an annual deductible for all drugs. The $125.00 annual deductible only applies to drugs on certain tiers.
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Premium Breakdown
AARP Medicare Advantage Walgreens (HMO) has a monthly premium of $0. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $170.10 | $0.00 | $0.00 | $0.00 | $170.10 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
AARP Medicare Advantage Walgreens (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $125.00 |
| Initial Coverage Limit: | $4,430.00 |
| Catastrophic Coverage Limit: | $7,050.00 |
| Drug Benefit Type: | Enhanced |
| Gap Coverage: | Yes |
| Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs. The table below shows how the LIS impacts the Part D premium of this plan.| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Initial Coverage Phase
After you pay your $125.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
60 Day
90 Day
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00, you will pay no more than the amounts below for any drug tier until you reach $7,050.00.
30 Day
90 Day
30 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $10.00 copay | ||
| 2 (Generic) * | $0.00 copay | $20.00 copay |
90 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $30.00 copay | $0.00 copay | $30.00 copay |
| 2 (Generic) * | $0.00 copay | $60.00 copay | $0.00 copay | $60.00 copay |
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Tier | Cost |
|---|---|
| Generic | $4.15 copay or 5% (whichever costs more) |
| Brand-name | $10.35 copay or 5% (whichever costs more) |
Additional Benefits
AARP Medicare Advantage Walgreens (HMO) also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network: No |
Dental (comprehensive)
| Diagnostic services: | Not covered |
| Endodontics: | Not covered |
| Extractions: | Not covered |
| Non-routine services: | Not covered |
| Periodontics: | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Not covered |
| Restorative services: | Not covered |
Dental (preventive)
| Cleaning: | $0 copay (limits may apply) |
| Dental x-ray(s): | $0 copay (limits may apply) |
| Fluoride treatment: | $0 copay (limits may apply) |
| Oral exam: | $0 copay (limits may apply) |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | $0-160 copay (authorization required) (referral required) |
| Diagnostic tests and procedures: | $30 copay (authorization required) (referral required) |
| Lab services: | $0 copay (authorization required) (referral required) |
| Outpatient x-rays: | $15 copay (authorization required) (referral required) |
Doctor visits
| Primary: | $0 copay |
| Specialist: | $50 copay per visit (authorization required) (referral required) |
Emergency care/Urgent care
| Emergency: | $90 copay per visit (always covered) |
| Urgent care: | $40 copay per visit (always covered) |
Foot care (podiatry services)
| Foot exams and treatment: | $50 copay (authorization required) (referral required) |
| Routine foot care: | $50 copay (limits may apply) (authorization required) (referral required) |
Ground ambulance
| $270 copay |
Health plan deductible
| $0.00 |
Health plan deductibles (other)
| In-Network: No |
Hearing
| Fitting/evaluation: | Not covered |
| Hearing aids: | $375-1,425 copay (limits may apply) (authorization required) |
| Hearing exam: | $0 copay (authorization required) (referral required) |
Hospital coverage (inpatient)
| $400 per day for days 1 through 4 $0 per day for days 5 through 90 $0 per day for days 91 and beyond (authorization required) (referral required) |
Hospital coverage (outpatient)
| $0-300 copay per visit (authorization required) (referral required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $5,900 In-network |
Medical equipment/supplies
| Diabetes supplies: | $0 copay per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 20% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | 20% coinsurance per item (authorization required) |
Medicare Part B drugs
| Chemotherapy: | 20% coinsurance (authorization required) |
| Other Part B drugs: | 0-20% coinsurance (authorization required) |
Mental health services
| Inpatient hospital – psychiatric: | $400 per day for days 1 through 4 $0 per day for days 5 through 90 (authorization required) (referral required) |
| Outpatient group therapy visit with a psychiatrist: | $15 copay (authorization required) (referral required) |
| Outpatient group therapy visit: | $15 copay (authorization required) (referral required) |
| Outpatient individual therapy visit with a psychiatrist: | $25 copay (authorization required) (referral required) |
| Outpatient individual therapy visit: | $25 copay (authorization required) (referral required) |
Optional supplemental benefits
| Yes |
Preventive care
| $0 copay |
Rehabilitation services
| Occupational therapy visit: | $40 copay (authorization required) (referral required) |
| Physical therapy and speech and language therapy visit: | $40 copay (authorization required) (referral required) |
Skilled Nursing Facility
| $0 per day for days 1 through 20 $188 per day for days 21 through 52 $0 per day for days 53 through 100 (authorization required) (referral required) |
Transportation
| Not covered |
Vision
| Contact lenses: | $0 copay (limits may apply) (referral required) |
| Eyeglass frames: | Not covered |
| Eyeglass lenses: | Not covered |
| Eyeglasses (frames and lenses): | $0 copay (limits may apply) (referral required) |
| Other: | Not covered |
| Routine eye exam: | $0 copay (limits may apply) (authorization required) (referral required) |
| Upgrades: | Not covered |
Wellness programs (e.g., fitness, nursing hotline)
| Covered |
Optional Benefits
Package #1
| Preventive dental: | Monthly Premium: | $40.00 |
| Preventive dental: | Deductible: | N/A |
| Comprehensive dental: | Monthly Premium: | $40.00 |
| Comprehensive dental: | Deductible: | N/A |
Ready to sign up for AARP Medicare Advantage Walgreens (HMO) ?