UHC Complete Care Support CA-4AP (HMO C-SNP)
Health Insurance Company: UnitedHealthcareⓇ
Medicare Advantage Plan Details
Chronic Condition (C-SNP)
- Rx
- Dental
- Vision
- Hearing
General Plan Details
Additional Benefits
Doctor & Hospital Coverage
Emergency Room
$110 copay per visit (always covered)
Ambulance Coverage
20% coinsurance
Lab, X-Ray, Radiology Coverage
Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: $0 copay
Medicare-covered lab services: $0 copay
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): 0-20% coinsurance
Medicare-covered x-ray services: 20% coinsurance
Outpatient Surgery Coverage
Outpatient hospital:
Medicare-covered outpatient hospital services: 0-20% coinsurance per visit
Hospitalization Coverage
Inpatient hospital-acute:
$1,415 per stay
$0 per day for days 91 and beyond
Inpatient hospital psychiatric:
$1,415 per stay
Rehabilitation Coverage
Occupational therapy services:
0-20% coinsurance
Physical therapy and speech and language therapy services:
0-20% coinsurance
Urgent Care Coverage
$0-45 copay per visit (always covered)
Skilled Nursing Facility (SNF)
Coming soon
Mental Health Coverage
Medicare-covered individual sessions: 0-20% coinsurance
Medicare-covered group sessions: 20% coinsurance
Dental, Vision, Hearing Benefits
Dental Services
Oral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay
Vision Benefits
Eye exams:
Routine eye exams: $0 copay
Eyewear:
Contact Lenses: $0 copay
Eyeglasses: Not covered
Hearing Benefits
Hearing exams:
Routine hearing exams: 20% coinsurance
Hearing aids:
Hearing aids (all types): $0 copay
More Additional Benefits
Plan Links
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