Uphams Corner Health Committee, Inc. (PACE)

H2220 - 002 - 0
Plan Not Rated

Uphams Corner Health Committee, Inc. (PACE) is a Medicare Advantage (Part C) Plan by Upham s PACE.

Uphams Corner Health Committee, Inc. (PACE) is a Medicare Advantage (Part C) PACE plan by Upham s PACE.

IMPORTANT: Uphams Corner Health Committee, Inc. (PACE) is a PACE plan. Program of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program for people who are 55 or older, live in the service area of a PACE organization, need a nursing home-level of care (as certified by your state), and are able to live safely in the community with help from PACE.

This page features plan details for 2024 Uphams Corner Health Committee, Inc. (PACE) H2220 – 002 – 0 available in Upham’s PACE.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

Uphams Corner Health Committee, Inc. (PACE) is offered in the following locations.

Plan Overview

Uphams Corner Health Committee, Inc. (PACE) offers the following coverage and cost-sharing.

Insurer:Upham s PACE
Health Plan Deductible:$0.00
MOOP:Not Applicable
Drugs Covered:Yes

Ready to sign up for Uphams Corner Health Committee, Inc. (PACE) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

Uphams Corner Health Committee, Inc. (PACE) has a monthly premium of $1292.20. 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
$174.70 $0.00 $1292.20 $0.00 $1466.90
Please Note:
  • 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

Uphams Corner Health Committee, Inc. (PACE) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:$
Initial Coverage Limit:$
Catastrophic Coverage Limit:$8,000.00
Drug Benefit Type:
Additional Gap Coverage:
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 DLIS Full
$1292.20$1,248.70

NOTE:  The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.

Initial Coverage Phase

After you pay your $ 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 $. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.

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 $8,000.00, you pay nothing for Medicare Part D covered drugs.

Additional Benefits

Uphams Corner Health Committee, Inc. (PACE) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

Not Applicable

Optional supplemental benefits

No

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network No

Outpatient hospital coverage

Not Applicable (Not applicable.) (Not applicable.)

Doctor visits

PrimaryNot Applicable (Not applicable.) (Not applicable.)
SpecialistNot Applicable (Not applicable.) (Not applicable.)

Preventive care

$0 copay (Not applicable.) (Not applicable.)

Emergency care/Urgent care

EmergencyNot Applicable (Not applicable.) (Not applicable.)
Urgent careNot Applicable (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

Diagnostic tests and proceduresNot Applicable (Not applicable.) (Not applicable.)
Lab servicesNot Applicable (Not applicable.) (Not applicable.)
Diagnostic radiology services (e.g., MRI)Not Applicable (Not applicable.) (Not applicable.)
Outpatient x-raysNot Applicable (Not applicable.) (Not applicable.)

Hearing

Hearing examNot Applicable (Not applicable.) (Not applicable.)
Fitting/evaluationNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids – inner earNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids – outer earNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids – over the earNot covered (There are no limits.) (Not applicable.) (Not applicable.)

Preventive dental

Oral examNot covered (There are no limits.) (Not applicable.) (Not applicable.)
CleaningNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Fluoride treatmentNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Dental x-ray(s)Not covered (There are no limits.) (Not applicable.) (Not applicable.)

Comprehensive dental

Non-routine servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Diagnostic servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Restorative servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
EndodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
PeriodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
ExtractionsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)

Vision

Routine eye examNot covered (There are no limits.) (Not applicable.) (Not applicable.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Contact lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglasses (frames and lenses)Not covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

Occupational therapy visitNot Applicable (Not applicable.) (Not applicable.)
Physical therapy and speech and language therapy visitNot Applicable (Not applicable.) (Not applicable.)

Ground ambulance

Not Applicable (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

Foot exams and treatmentNot Applicable (Not applicable.) (Not applicable.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)Not Applicable (Not applicable.) (Not applicable.)
Prosthetics (e.g., braces, artificial limbs)Not Applicable (Not applicable.) (Not applicable.)
Diabetes suppliesNot Applicable (Not applicable.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Not covered (Not applicable.) (Not applicable.)

Medicare Part B drugs

ChemotherapyNot Applicable (Not applicable.) (Not applicable.)
Other Part B drugsNot Applicable (Not applicable.) (Not applicable.)
Part B Insulin drugsNot Applicable (Not applicable.) (Not applicable.)

Inpatient hospital coverage

Not Applicable (Not applicable.) (Not applicable.)

Mental health services

Inpatient hospital – psychiatricNot Applicable (Not applicable.) (Not applicable.)
Outpatient group therapy visit with a psychiatristNot Applicable (Not applicable.) (Not applicable.)
Outpatient individual therapy visit with a psychiatristNot Applicable (Not applicable.) (Not applicable.)
Outpatient group therapy visitNot Applicable (Not applicable.) (Not applicable.)
Outpatient individual therapy visitNot Applicable (Not applicable.) (Not applicable.)

Skilled Nursing Facility

$0 copay per stay (Not applicable.) (Not applicable.)

Ready to sign up for Uphams Corner Health Committee, Inc. (PACE) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

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