UHC MedicareDirect Patriot No Rx PF-MA01 (PFFS)
H5435 - 001 - 0
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UHC MedicareDirect Patriot No Rx PF-MA01 (PFFS) is a Medicare Advantage (Part C) Plan by UnitedHealthcare.
This page features plan details for 2024 UHC MedicareDirect Patriot No Rx PF-MA01 (PFFS) H5435 – 001 – 0 available in Select Counties in KS, MT, NE, and WY.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
UHC MedicareDirect Patriot No Rx PF-MA01 (PFFS) is offered in the following locations.
Plan Overview
UHC MedicareDirect Patriot No Rx PF-MA01 (PFFS) offers the following coverage and cost-sharing.
| Insurer: | UnitedHealthcare |
| Health Plan Deductible: | $0.00 |
| MOOP: | $6,700.00 |
| Drugs Covered: | No |
Ready to sign up for UHC MedicareDirect Patriot No Rx PF-MA01 (PFFS) ?
Premium Breakdown
UHC MedicareDirect Patriot No Rx PF-MA01 (PFFS) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $0.00 | $0.00 | $174.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
UHC MedicareDirect Patriot No Rx PF-MA01 (PFFS) also provides the following benefits.
| $0 |
| In-network | No |
| $6,700 |
| No |
| In-network | No |
| $0-420 copay per visit (Not applicable.) (Not applicable.) |
| Primary | $0-20 copay per visit (Not applicable.) (Not applicable.) |
| Specialist | $0-55 copay per visit (Not applicable.) (Not applicable.) |
| $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $100 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $0-40 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | $50 copay (Not applicable.) (Not applicable.) |
| Lab services | $0 copay (Not applicable.) (Not applicable.) |
| Diagnostic radiology services (e.g., MRI) | $0-250 copay (Not applicable.) (Not applicable.) |
| Outpatient x-rays | $25 copay (Not applicable.) (Not applicable.) |
| Hearing exam | $20 copay (Not applicable.) (Not applicable.) |
| Fitting/evaluation | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Hearing aids | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Oral exam | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Cleaning | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Fluoride treatment | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Dental x-ray(s) | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Non-routine services | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Diagnostic services | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Restorative services | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Endodontics | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Periodontics | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Extractions | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | 0-50% coinsurance (Limits may apply.) (Not applicable.) (Not applicable.) |
| Routine eye exam | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| Occupational therapy visit | $0-40 copay (Not applicable.) (Not applicable.) |
| Physical therapy and speech and language therapy visit | $0-40 copay (Not applicable.) (Not applicable.) |
| $290 copay (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| Foot exams and treatment | $55 copay (Not applicable.) (Not applicable.) |
| Routine foot care | $55 copay (Limits may apply.) (Not applicable.) (Not applicable.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Not applicable.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Not applicable.) (Not applicable.) |
| Diabetes supplies | $0 copay per item (Not applicable.) (Not applicable.) |
| Covered (Not applicable.) (Not applicable.) |
| Chemotherapy | 0-20% coinsurance (Not applicable.) (Not applicable.) |
| Other Part B drugs | 0-20% coinsurance (Not applicable.) (Not applicable.) |
| Part B Insulin drugs | 0-20% coinsurance (up to $35) (Not applicable.) (Not applicable.) |
| $420 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 and beyond (Not applicable.) (Not applicable.) |
| Inpatient hospital – psychiatric | $420 per day for days 1 through 4 $0 per day for days 5 through 90 (Not applicable.) (Not applicable.) |
| Outpatient group therapy visit with a psychiatrist | $15 copay (Not applicable.) (Not applicable.) |
| Outpatient individual therapy visit with a psychiatrist | $0-25 copay (Not applicable.) (Not applicable.) |
| Outpatient group therapy visit | $15 copay (Not applicable.) (Not applicable.) |
| Outpatient individual therapy visit | $0-25 copay (Not applicable.) (Not applicable.) |
| $0 per day for days 1 through 20 $203 per day for days 21 through 100 (Not applicable.) (Not applicable.) |
Ready to sign up for UHC MedicareDirect Patriot No Rx PF-MA01 (PFFS) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
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