Y0066_EOC_H0271_046_000_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de CoberturaNumber of Members enrolled in this plan in (H0271 - 036): 2,359 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...Resumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que2023 Medicare Part D Contract ID/Plan ID Search. Q1Medicare.com providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State.Medicare Advantage plan with prescription drugs Summary of benefits 2022 UnitedHealthcare Dual Complete® (HMO D-SNP) H0624-001-000 Look inside to take advantage of the health services and drug coverages the plan provides.Navigate to the CMS Enterprise Portal public home page. Login using your user ID and password. The CMS Enterprise Portal My Portal page is displayed, as shown in Figure 59: My Portal Page – My Profile Drop-down. Select the down arrow icon that appears next to your name at the top of page. Then select My Profile from the drop-down list to ... Jan 1, 2023 · Y0066_SB_H0271_027_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... 2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. Y0066_SB_H0271_036_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...The UnitedHealthcare Dual Complete Choice (PPO D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $0 per year. Coverage. Cost. 30 day supply. 60 day supply. 90 day supply. Coverage & Cost. 30 day supply. 60 day supply.2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State.The UnitedHealthcare Chronic Complete Assure (PPO C-SNP) offers prescription drug coverage, with an annual drug deductible of $505.00 (excludes Tiers 1, 2 and 3) Coverage. Cost. 30 day supply. 60 day supply. 90 day supply. Coverage & Cost. 30 day supply. 60 day supply.2023 Colorado UnitedHealthcare Dual Complete® Plan Frequently Asked Questions: Plan H0271-046-000 Subject: UnitedHealthcare Community Plan of Colorado manages the Medicare Advantage benefits and reimburses you according to your existing contracted rates. Please make sure to always validate eligibility and benefits before providing service.TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Medicare Advantage Assure (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $29.10 (see Plan Premium Details below) Annual Deductible: $480. Annual Initial Coverage Limit (ICL):8 a.m.-8 p.m. local time, 7 days a week UHC.com/Medicare Y0066_SB_H0271_046_000_2023_M Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of Coverage (EOC) for a complete list of covered services, limitations and exclusions.Evidence of Coverage 2023 UnitedHealthcare® Chronic Complete Assure (PPO C-SNP) Toll-free 1-877-370-3249, TTY 711 24 hours a day, 7 days a week myUHCMedicare.com Y0066_EOC_H0271_036_000_2023_CH0271 - 060 - 1 Click to see other plans: Member Services: 1-800-514-4912 TTY users 711 — Enrollment Options — Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 or contact your local SHIP for assistance: Email a copy of the UnitedHealthcare Dual Complete Choice (PPO D-SNP) benefit details Y0066_EOC_H0271_046_000_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura 2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete Choice (PPO D-SNP) Location: Denver, Colorado Click to see other locations. Plan ID: H0271 - 046 - 0 Click to see other plans. Member Services: 1-866-480-1086 TTY users 711.This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 046 – 0 available in Select Counties in Colorado. IMPORTANT : This page has been updated with plan and premium data for 2023.2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State.Y0066_SB_H0271_036_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...Home Medicare Medicare Plans UnitedHealthcare Dual Complete Choice (PPO D-SNP) UnitedHealthcare Dual Complete Choice (PPO D-SNP) 4 out of 5 stars UnitedHealthcare Dual Complete Choice (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0271-046. $ 0.00 Monthly Premium Colorado Counties Served h0271-046-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan.The UnitedHealthcare Chronic Complete Assure (PPO C-SNP) offers prescription drug coverage, with an annual drug deductible of $505.00 (excludes Tiers 1, 2 and 3) Coverage. Cost. 30 day supply. 60 day supply. 90 day supply. Coverage & Cost. 30 day supply. 60 day supply.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 $1000.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined. Y0066_SB_H0271_016_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...2023 Colorado UnitedHealthcare Dual Complete® Plan Frequently Asked Questions: Plan H0271-046-000 Subject: UnitedHealthcare Community Plan of Colorado manages the Medicare Advantage benefits and reimburses you according to your existing contracted rates. Please make sure to always validate eligibility and benefits before providing service.Y0066_EOC_H0271_046_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverageo UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ Femenino Y0066_SB_H0271_006_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...Y0066_EOC_H0271_046_000_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Coberturah0271-005-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan.UnitedHealthcare - H0271 For 2023, UnitedHealthcare - H0271 received the following Star Ratings from Medicare: Overall Star Rating: 4 stars Health Services Rating: 3.5 stars Drug Services Rating: 3 stars Every year, Medicare evaluates plans based on a 5-star rating system. Why Star Ratings are Important Medicare rates plans on their health and ...2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State.Y0066_SB_H0271_036_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H0271-045-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H0271-046-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H0624-001-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H2582-002-000 2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. UnitedHealthcare offers UnitedHealthcare Dual Complete® (PPO D-SNP) H0271-046-000 plans for Colorado and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools. This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 046 – 0 available in Select Counties in Colorado. IMPORTANT : This page has been updated with plan and premium data for 2023.Resumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que Navigate to the CMS Enterprise Portal public home page. Login using your user ID and password. The CMS Enterprise Portal My Portal page is displayed, as shown in Figure 59: My Portal Page – My Profile Drop-down. Select the down arrow icon that appears next to your name at the top of page. Then select My Profile from the drop-down list to ...The following UnitedHealthCare plans are accepted at Oak Street Health locations. Plan Name. Effective Year. Benefit Package. Summary. AARP Medicare Advantage. 2023. H1944-024. AARP Medicare Advantage. H0271-046-000 Service area: Colorado - Adams, Alamosa, Arapahoe, Bent, Boulder, Broomfield, Chaffee, Clear Creek, Conejos, Costilla, Crowley, Custer, Denver, Douglas, El Paso, Elbert, Fremont, Gilpin, Grand, Huerfano, Jefferson, Lake, Larimer, Las Animas, Lincoln, Logan, Morgan, Otero, Park, Pueblo, Teller, Washington, Weld countiesCopayment 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 $4500.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined.Navigate to the CMS Enterprise Portal public home page. Login using your user ID and password. The CMS Enterprise Portal My Portal page is displayed, as shown in Figure 59: My Portal Page – My Profile Drop-down. Select the down arrow icon that appears next to your name at the top of page. Then select My Profile from the drop-down list to ... Y0066_SB_H0271_006_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...Guía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 Área de servicio: Colorado - condados de Adams, Alamosa, Arapahoe, Bent, Boulder, Broomfield,2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State.Y0066_SB_H0271_027_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...H0271 027 * 4. Christian. UnitedHealthcare; UnitedHealthcare Chronic Complete Assure (PPO C-SNP) Local PPO Chronic or Disabling Condition $ 9.80 $ 505.00 No; DS H0271;Y0066_EOC_H0271_046_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Jan 1, 2023 · Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 Service area: Colorado - Adams, Alamosa, Arapahoe, Bent, Boulder, Broomfield, Chaffee, Clear 2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete Balance (PPO D-SNP) Location: Litchfield, Connecticut Click to see other locations. Plan ID: H0271 - 059 - 0 Click to see other plans. Member Services: 1-866-272-1967 TTY users 711.The following UnitedHealthCare plans are accepted at Oak Street Health locations. Plan Name. Effective Year. Benefit Package. Summary. AARP Medicare Advantage. 2023. H1944-024. AARP Medicare Advantage.Resumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud queLearn more about the UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 plan for Colorado. Check eligibility, explore benefits, and enroll today. Hmm … it looks like your browser is out of date.H0271 - 036 - 0 Click to see other plans: Member Services: 1-800-643-4845 TTY users 711 — This plan information is for research purposes only. — Click here to see plans for the current plan year: Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 or contact your local SHIP for assistance H0271 - 027 - 0 Click to see other plans: Member Services: 1-800-643-4845 TTY users 711 — This plan information is for research purposes only. — Click here to see plans for the current plan year: Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 or contact your local SHIP for assistance o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ Femenino OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage Y0066_EOC_H0271_046_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H0271-045-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H0271-046-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H0624-001-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H2582-002-000Plan ID: H0271-060-001. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. New York 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 ...2022 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (PPO D-SNP) Location: Kanawha, West Virginia Click to see other locations. Plan ID: H0271 - 013 - 0 Click to see other plans. Member Services: 1-866-480-1086 TTY users 711.Specialty doctor visit. $40 in-network / $50 out-of-network. Inpatient hospital care. $300 per day, days 1-7; $0 per day, days 8-90 in-network / 50% per stay out-of-network. Urgent care. Urgent Care: Copayment for Urgent Care $60.00. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $110.00.2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. 2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage Resumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que 2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State.Jan 1, 2023 · Summary of Benefits 2023 UnitedHealthcare® Chronic Complete Assure (PPO C-SNP) H0271-043-000 Look inside to take advantage of the health services and drug coverages the plan provides. Jan 1, 2023 · Summary of Benefits 2023 UnitedHealthcare® Chronic Complete Assure (PPO C-SNP) H0271-043-000 Look inside to take advantage of the health services and drug coverages the plan provides. UnitedHealthcare - H0271 En el año 2023, UnitedHealthcare - H0271 recibió las siguientes Calificaciones con Estrellas de Medicare: Calificación General por Estrellas: 4 estrellas Calificación de los Servicios de Salud: 3.5 estrellas Calificación de los Servicios de Medicamentos: 3 estrellas Resumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud queHome Medicare Medicare Plans UnitedHealthcare Dual Complete Choice (PPO D-SNP) UnitedHealthcare Dual Complete Choice (PPO D-SNP) 4 out of 5 stars UnitedHealthcare Dual Complete Choice (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0271-046. $ 0.00 Monthly Premium Colorado Counties Served TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Medicare Advantage Assure (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $29.10 (see Plan Premium Details below) Annual Deductible: $480. Annual Initial Coverage Limit (ICL): 2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security NumberThe average monthly premium for Medicare Advantage plans in Denver is $13.91 per month in 2023, though there may be plans available where you live that feature different premiums. Medicare Advantage plans in Denver County have an average Medicare Star Rating of 3.78 in 2023.*. Plans rated four stars or higher are considered top-rated Medicare ... Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 Service area: Colorado - Adams, Alamosa, Arapahoe, Bent, Boulder, Broomfield, Chaffee, Clear Jan 1, 2023 · Y0066_SB_H0271_005_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... Y0066_SB_H0271_027_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 Service area: Colorado - Adams, Alamosa, Arapahoe, Bent, Boulder, Broomfield, Chaffee, ClearNumber of Members enrolled in this plan in (H0271 - 027): 4,053 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...H0271 - 046 - 0 Click to see other plans: Member Services: 1-866-480-1086 TTY users 711 — Enrollment Options — Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 or contact your local SHIP for assistance: Email a copy of the UnitedHealthcare Dual Complete Choice (PPO D-SNP) benefit detailsH0271 - 060 - 1 Click to see other plans: Member Services: 1-800-514-4912 TTY users 711 — Enrollment Options — Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 or contact your local SHIP for assistance: Email a copy of the UnitedHealthcare Dual Complete Choice (PPO D-SNP) benefit details
533 Medicare Advantage Plans from UnitedHealthcare. Coverage varies by plan. Select a Medicare Advantage Plan below to view details about the coverage it provides: Plan CodePlan Name. H0271:007-0 UnitedHealthcare Medicare Advantage Assure (PPO) H0271:012-0 UnitedHealthcare Medicare Advantage Assure (PPO) H0271:017-0 UnitedHealthcare Medicare .... Eandj junkyard
The following UnitedHealthCare plans are accepted at Oak Street Health locations. Plan Name. Effective Year. Benefit Package. Summary. AARP Medicare Advantage. 2023. H1944-024. AARP Medicare Advantage. 2023 Colorado UnitedHealthcare Dual Complete® Plan Frequently Asked Questions: Plan H0271-046-000 Subject: UnitedHealthcare Community Plan of Colorado manages the Medicare Advantage benefits and reimburses you according to your existing contracted rates. Please make sure to always validate eligibility and benefits before providing service.h0271-046-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan.Y0066_EOC_H0271_046_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. Plan ID: H0271-060-001. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. New York 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 ...UnitedHealthcare - H0271 For 2023, UnitedHealthcare - H0271 received the following Star Ratings from Medicare: Overall Star Rating: 4 stars Health Services Rating: 3.5 stars Drug Services Rating: 3 stars Every year, Medicare evaluates plans based on a 5-star rating system. Why Star Ratings are Important Medicare rates plans on their health and ...UnitedHealthcare - H0271 For 2023, UnitedHealthcare - H0271 received the following Star Ratings from Medicare: Overall Star Rating: 4 stars Health Services Rating: 3.5 stars Drug Services Rating: 3 stars Every year, Medicare evaluates plans based on a 5-star rating system. Why Star Ratings are Important Medicare rates plans on their health and ... Navigate to the CMS Enterprise Portal public home page. Login using your user ID and password. The CMS Enterprise Portal My Portal page is displayed, as shown in Figure 59: My Portal Page – My Profile Drop-down. Select the down arrow icon that appears next to your name at the top of page. Then select My Profile from the drop-down list to ...The UnitedHealthcare Chronic Complete Assure (PPO C-SNP) offers prescription drug coverage, with an annual drug deductible of $505.00 (excludes Tiers 1, 2 and 3) Coverage. Cost. 30 day supply. 60 day supply. 90 day supply. Coverage & Cost. 30 day supply. 60 day supply.8 a.m.-8 p.m. local time, 7 days a week UHC.com/Medicare Y0066_SB_H0271_046_000_2023_M Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of Coverage (EOC) for a complete list of covered services, limitations and exclusions.OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage 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 $1000.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined.H0271 - 027 - 0 Click to see other plans: Member Services: 1-800-643-4845 TTY users 711 — This plan information is for research purposes only. — Click here to see plans for the current plan year: Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 or contact your local SHIP for assistance 2023 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. Guía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-046-000 Área de servicio: Colorado - condados de Adams, Alamosa, Arapahoe, Bent, Boulder, Broomfield,Plan ID: H0271-036-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $13.30 Monthly Premium. Oregon 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 ...Y0066_SB_H0271_036_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...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 $4500.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined. H0271 - 027 - 0 Click to see other plans: Member Services: 1-800-643-4845 TTY users 711 — This plan information is for research purposes only. — Click here to see plans for the current plan year: Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 or contact your local SHIP for assistance .