UnitedHealthcare Medicare Advantage Assure (PPO) H0271-004-000 2022 Plan Details and Costs (2024)

4 out of 5 stars* for plan year 2022

$29.10 Monthly Premium

UnitedHealthcare Medicare Advantage Assure (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare

Plan ID: H0271-004-000

$29.10 Monthly Premium

Illinois Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Illinois Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage	Details
Monthly plan premium	$29.10
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible	$480.00
Out-of-pocket maximum	$7,550.00
Initial drug coverage limit	$4,430.00
Catastrophic drug coverage limit	$7,050.00
Primary care doctor visit	In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0.00
Specialty doctor visit	Out-of-Network: Doctor Specialty Visit: Coinsurance for Medicare Covered Physician Specialist Office Visit 30%
Inpatient hospital care	In-Network: Acute Hospital Services: $275.00 per day for days 1 to 6 $0.00 per day for days 7 to 90 Prior Authorization Required for Acute Hospital Services
Urgent care	Urgent Care: Copayment for Urgent Care $65.00 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0.00
Emergency room visit	Emergency Care: Copayment for Emergency Care $90.00 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $0.00 Copayment for Worldwide Emergency Transportation $0.00
Ambulance transportation	In-Network: Ground Ambulance: Coinsurance for Ground Ambulance Services 20% Air Ambulance: Coinsurance for Air Ambulance Services 20% Section B - General 10a Note - NOTE ON AUTHORIZATION: Authorization is required for Non-emergency Medicare-covered ambulance ground and air transportation. Emergency Ambulance does not require authorization. Please see Evidence of Coverage for Prior Authorization rules

Health Care Services and Medical Supplies

UnitedHealthcare Medicare Advantage Assure (PPO) covers a range of additional benefits. Learn more about UnitedHealthcare Medicare Advantage Assure (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage	Details
Chiropractic services	In-Network: Chiropractic Services: Coinsurance for Medicare-covered Chiropractic Services 20% Prior Authorization Required for Chiropractic Services
Diabetes supplies, training, nutrition therapy and monitoring	Out-of-Network: Diabetic Supplies and Services: Coinsurance for Medicare Covered Diabetic Supplies and Services 50%
Durable medical equipment (DME)	Out-of-Network: Durable Medical Equipment: Coinsurance for Medicare Covered Durable Medical Equipment 50%
Diagnostic tests, lab and radiology services, and X-rays	Out-of-Network: Outpatient Diag Procs/Tests/Lab Services: Coinsurance for Medicare Covered Diagnostic Procedures/Tests 30% Copayment for Medicare Covered Lab Services $0.00 Coinsurance for Medicare Covered Diagnostic Radiological Services 30% Coinsurance for Medicare Covered Therapeutic Radiological Services 30% Coinsurance for Medicare Covered Outpatient X-Ray Services 30%
Home health care	Out-of-Network: Home Health Services: Coinsurance for Medicare Covered Home Health 50%
Mental health inpatient care	In-Network: Psychiatric Hospital Services: $275.00 per day for days 1 to 6 $0.00 per day for days 7 to 90 Prior Authorization Required for Psychiatric Hospital Services
Mental health outpatient care	In-Network: Outpatient Mental Health Services: Coinsurance for Medicare-covered Individual Sessions 20% Coinsurance for Medicare-covered Group Sessions 20% Prior Authorization Required for Outpatient Mental Health Services
Outpatient services/surgery	Out-of-Network: Outpatient Hospital and ASC Services: Coinsurance for Medicare Covered Outpatient Hospital Services 30% Coinsurance for Medicare Covered Ambulatory Surgical Center Services 30%
Outpatient substance abuse care	In-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare-covered Individual Sessions 20% Coinsurance for Medicare-covered Group Sessions 20% Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter items	In-Network: Over-The-Counter (OTC) Items: Copayment for Over-The-Counter (OTC) Items $0.00 Maximum Plan Benefit of $210.00 every three months Nicotine Replacement Therapy (NRT) offerred as a Part C OTC benefit
Podiatry services	Out-of-Network: Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 30% Podiatry Services: Coinsurance for Non-Medicare Covered Podiatry Services 30%
Skilled Nursing Facility (SNF) care	Out-of-Network: Coinsurance for Skilled Nursing Facility Services per Stay 30%

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Dental care	In-Network: Preventive Dental: Copayment for Oral Exams $0.00 Maximum 2 visits every year Copayment for Prophylaxis (Cleaning) $0.00 Maximum 3 visits every year Copayment for Fluoride Treatment $0.00 Maximum 2 visits every year Copayment for Dental X-Rays $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3500.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined Comprehensive Dental: Coinsurance for Medicare-covered Benefits 20% Copayment for Non-routine Services $0.00 Copayment for Diagnostic Services $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Copayment for Restorative Services $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Copayment for Endodontics $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Copayment for Periodontics $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Copayment for Extractions $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00 Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3500.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined Prior Authorization Required for Comprehensive Dental

Coverage

Details

Dental care

In-Network:

Preventive Dental:
Copayment for Oral Exams $0.00

Maximum 2 visits every year

Copayment for Prophylaxis (Cleaning) $0.00

Maximum 3 visits every year

Copayment for Fluoride Treatment $0.00

Maximum 2 visits every year

Copayment for Dental X-Rays $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Maximum Plan Benefit of $3500.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined

Comprehensive Dental:
Coinsurance for Medicare-covered Benefits 20%
Copayment for Non-routine Services $0.00
Copayment for Diagnostic Services $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Restorative Services $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Endodontics $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Periodontics $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Extractions $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00

Maximum 1 visit (Please see Evidence of Coverage for details)

Maximum Plan Benefit of $3500.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined
Prior Authorization Required for Comprehensive Dental

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Vision benefits	Out-of-Network: Medicare Covered Vision Services: Coinsurance for Medicare Covered Eye Exams 30% Coinsurance for Medicare Covered Eyewear 30% Non-Medicare Covered Vision Services: Coinsurance for Non-Medicare Covered Eye Exams 30% Copayment for Non-Medicare Covered Eyewear $0.00

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Hearing benefits	Out-of-Network: Medicare Covered Hearing Services: Coinsurance for Medicare Covered Hearing Exams 30% Non-Medicare Covered Hearing Services: Coinsurance for Non-Medicare Covered Hearing Exams 30% Copayment for Non-Medicare Covered Hearing Aids $0.00

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Preventive services and health/wellness education programs	In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vagin*l cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots: COVID-19 shots Flu shots Hepatitis B shots Pneumococcal shots Tobacco use cessation Yearly "Wellness" visit

Coverage

Details

Preventive services and health/wellness education programs

In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vagin*l cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:

COVID-19 shots

Flu shots

Hepatitis B shots

Pneumococcal shots

Tobacco use cessation
Yearly "Wellness" visit

Prescription Drug Costs and Coverage

The UnitedHealthcare Medicare Advantage Assure (PPO) offers prescription drug coverage, with an annual drug deductible of $480.00 (excludes Tier 1)

Coverage	Cost
Coverage & Cost
Annual drug deductible	$480.00 (excludes Tier 1)
Tier 1	Preferred retail 25% Standard retail 25% Preferred mail order 25% Standard mail order 25%
Annual drug deductible	$480.00 (excludes Tier 1)
Tier 1	Preferred retail N/A Standard retail N/A Preferred mail order N/A Standard mail order N/A
Annual drug deductible	$480.00 (excludes Tier 1)
Tier 1	Preferred retail 25% Standard retail 25% Preferred mail order 25% Standard mail order 25%

When reviewing Illinois Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

You may be able to find plans in your part of Illinois that offer similar benefits at similar or lower prices than the plan above. Call 1-855-580-1854 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

Plan Documents

Links to plan documents

Summary of benefits
Star ratings

Illinois Counties Served

Boone Bureau Carroll Cook Dekalb Dupage Henderson Henry Jo Daviess Kane Kankakee Kendall Knox Lake Lee Marshall Mchenry Mclean Mercer Ogle Peoria Putnam Rock Island Sangamon Stark Stephenson Tazewell Warren Whiteside Will Winnebago Woodford

We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

Back to plans in Illinois

UnitedHealthcare Medicare Advantage Assure (PPO) H0271-004-000 2022 Plan Details and Costs (2024)

FAQs

What is the true cost of Medicare Advantage plans? ›

The estimated average monthly Medicare Advantage plan premium for 2024 is $18.50, but this cost may vary based on the insurer and level of coverage. Some plan premiums could be $0, while others could be $200 or more. To join a Medicare Advantage plan, you must also be enrolled in Medicare Parts A and B.

Know More ›

What is the difference between Medicare and Medicare Advantage PPO? ›

Medicare Advantage is an alternative to traditional Medicare offered by private health insurance companies. Medicare Advantage plans cover all the same services under Original Medicare Part A and Part B, but often include prescription drug coverage and extra benefits.

Discover More Details ›

What is the difference between Medicare and UHC Medicare Advantage? ›

Original Medicare covers inpatient hospital and skilled nursing services – Part A - and doctor visits, outpatient services and some preventative care – Part B. Medicare Advantage plans cover all the above (Part A and Part B), and most plans also cover prescription drugs (Part D).

What costs count toward the out of pocket maximum for Medicare Advantage MA plans? ›

The out-of-pocket costs that help you reach your MOOP include all cost-sharing (deductibles, coinsurance, and copayments) for Part A and Part B covered services that you receive from in-network providers. Part D cost-sharing does not count towards your plan's MOOP.

See Details ›

Why do people say not to get a Medicare Advantage plan? ›

Restrictive networks

In some cases, you'll have a higher share of costs when you see an out-of-network doctor. In other cases, you're not covered at all if you go out of network. This is particularly important if you travel a lot because Medicare Advantage plans generally don't provide out-of-state coverage.

Discover More ›

What is the average monthly payment for a Medicare Advantage? ›

Medicare Advantage Plan Cost in Each State

State	Avg. Monthly Premium	Percentage Change from 2022
California	$16.42	-9.5%
Colorado	$13.71	-5.6%
Connecticut	$17.66	-13.9%
Delaware	$12.66	-11.2%

47 more rows

Oct 17, 2023

See Details ›

What is the biggest disadvantage of the Medicare Advantage plan? ›

The biggest disadvantage of Medicare Advantage is you'll have a more limited choice of doctors and medical offices than you would with Original Medicare. Medicare Advantage plans can also cost more overall if you have complex medical needs. These plans are best if you don't need expensive treatments or tests.

Get More Info ›

Why are people leaving Medicare Advantage plans? ›

Most individuals that dislike a Medicare Advantage plan usually have had a bad experience with in-network providers, plan authorizations for medical care, or having to wait a long time to have an appointment scheduled. Some of these concerns can be attributed to the healthcare provider.

Discover More ›

Can I drop my Medicare Advantage plan and go back to original Medicare? ›

You can drop your Medicare Advantage Plan and return to Original Medicare. You'll also be able to join a separate Medicare drug plan. During the Medicare Advantage Open Enrollment Period, if you have Original Medicare you can't: Switch to a Medicare Advantage Plan.

Discover More Details ›

What is the most highly rated Medicare Advantage plan? ›

Our Top Medicare Advantage Plans

Best Consumer Reputation: Blue Cross Blue Shield.
Best Nationwide Coverage: Humana.
Best Local Support Services: Aetna.
Largest Provider Network: UnitedHealthcare.
Best Additional Benefits: Cigna.
Best Overall CMS Rating: Anthem.

Jul 3, 2024

Keep Reading ›

Which is better, a supplement or advantage plan? ›

Medicare Advantage offers broader coverage including prescription drugs and dental care, while Medicare Supplement focuses on covering most out-of-pocket costs. Medicare Advantage plans are managed by private insurers with network restrictions, whereas Medicare Supplement allows freedom of provider choice.

Does UnitedHealthcare Medicare Advantage PPO require referrals? ›

Your primary care provider will help refer you to specialists when needed; however, a referral is not required. If you see a network provider, you'll pay a copay for the services you receive. If you see an out-of-network provider, you may pay the full cost of the services you receive.

Explore More ›

Does Medicare cover 100% of hospital bills? ›

Medicare doesn't typically cover 100% of your medical costs. Like most health insurance, Medicare generally comes with out-of-pocket costs including copayments, coinsurance, and deductibles. As you'll learn in this article, Original Medicare (Part A and Part B) costs can really add up.

Get More Info ›

Do Medicare Advantage plans cover the $20 copay? ›

Copayment: MA Plans usually charge a copayment (copay) for doctor's visits, instead of the 20% coinsurance you pay under Original Medicare. Keep in mind that MA Plans cannot charge higher copays than Original Medicare for certain care, including chemotherapy, dialysis, and skilled nursing facility (SNF) care.