Jun 21, 2018 Dual coverage is the industry term used when someone has coverage from more than one plan. This can happen in many ways. This can happen in many ways. You may have coverage from your employer and your spouse’s employer. CareSource Dual Advantage. Inpatient Hospital Care. Days 1 through 7 $0 copay per day. Days 8 through 90 $0 copay per day. Outpatient Hospital 1. Ambulatory surgical center $0 copay. Outpatient hospital $0 copay. Doctor’s Office Visits Primary care physician visit (Including Telehealth Visit) $0 copay. Specialist visit $0 copay.
- Dual Copay Program
- Dual Copay Coverage
- Dual Company Website
- Dual Copay Form
- Dual Eligible Prescription Copay
- Dual Copay Rates
- Dual Copay Rates
Dual plans combine the benefits of both Medicare and Medicare into one simple health plan. If you have Medicare and Medicare, chances are you could qualify for a dual plan. A small Medicaid copay.) Medicare Remittance Advice notices clearly indicate if a beneficiary is a QMB and show the beneficiary’s deductible, copayment, and coinsurance cost-sharing is zero. If a provider bills a QMB for Medicare cost-sharing, or turns a bill over to collections, the provider.
Dual Copay Program
You Deserve a Health Plan You Can Trust.
Don’t Worry, CareSource Has You Covered.
CareSource offers more benefits than basic Medicare. Our CareSource Dual Advantage™ (HMO D-SNP), is designed to provide you with the best care and save you money.
Apr 24, 2008 BBA-97, §4714, codified at 42 U.S.C. An example of the cost-sharing payment system allowed by the BBA is as follows: If Medicare allows $100 for a physician visit (and thus pays $80, or 80%), under full payment of cost sharing, the state would pay the full $20 remaining. But if the state’s rate for the same service is $80, the state will pay nothing, since Medicare has already.
You may find out more about your benefits and services by reviewing the Summary of Benefits or the Evidence of Coverage. These and other helpful documents are available on our Plan Documents page.
2021 Benefit Highlights
- $0 Copay for Primary Care Visits. At CareSource, we believe the best way for you to stay healthy and worry-free is to see your doctor regularly – not only just when you need to. So, we make sure it’s easy to afford. Our CareSource Dual Advantage plan offers $0 copays to visit your primary care provider (PCP).
- Preventive Services with $0 Copay. Our CareSource Dual Advantage plan covers many preventive services such as yearly “wellness” visits, mammograms, vaccines, and more with no copay!
- LOW Rx Copays. And to add to your savings, our copays for medications are low. $0 copayment for many generic drugs! That includes the most frequently prescribed medications.
- Dental Benefits. You can get dental exams and cleanings every six months — with no copays! Plus, our CareSource Dual Advantage plans offer comprehensive dental benefits, including coverage for dentures, extractions, and root canals through a $1,500 -$2,000 annual allowance.
- Vision and Hearing. Isn’t it nice to know that your plan includes coverage for hearing and eye exams? Vision coverage includes a $250 annual allowance for glasses or contact and a free eye exam. Hearing benefits include a $1,000 allowance per ear for hearing aids through a Choice Discount Program. Vision benefits cover eye exams, glasses, and contacts.
- Over the Counter (OTC) benefits. Receive a quarterly benefit of $125-$190 depending on where you live to pay for commonly used items.
- The Silver&Fit® Fitness Program. You can get fit at your local fitness center or in the comfort of your own home. Our plans include a variety of participating fitness centers across the country, at no additional cost to you. You may choose to receive up to two home fitness kits with videos and equipment to get you moving at no additional cost. In addition, Silver&Fit includes a guest wavier pass for a caregiver.
- Meal Delivery. Meal benefits include 2 meals per day for 14 days after an inpatient hospital discharge.
This information is not a complete description of benefits. Call 1-833-230-2020 (TTY: 711) for more information.
UnitedHealthcare Dual Complete (PPO D-SNP) is a 2020 Medicare Advantage Special Needs Plan plan by UnitedHealthcare. This plan from UnitedHealthcare works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from UnitedHealthcare and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. UnitedHealthcare Dual Complete (PPO D-SNP) DS-H0271 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.
2020 Medicare Special Needs Plan Details
| Plan Name: | |
|---|---|
| Plan ID: | DS-H0271 |
| Special Needs Type: | Dual-Eligible |
| Provider: | UnitedHealthcare |
| Plan Year: | 2020 |
| Plan Type: | Local PPO |
| Monthly Premium C+D: | $28.00 |
The UnitedHealthcare Dual Complete (PPO D-SNP) DS-H0271 is available to residents in Indiana, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. UnitedHealthcare Dual Complete (PPO D-SNP) is a Local PPO. A preferred provider organization (PPO) is a medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
Part-C Premium
UnitedHealthcare plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
The UnitedHealthcare Dual Complete (PPO D-SNP) plan has a monthly drug premium of $28.00 and a $435.00 drug deductible. This UnitedHealthcare plan offers a $28.00 Part D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by UnitedHealthcare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $28.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Premium Assistance
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The UnitedHealthcare Dual Complete (PPO D-SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $7.00 for 75% low income subsidy $14.00 for 50% and $21.00 for 25%.
| Part C Premium: | $0.00 |
|---|---|
| Part D (Drug) Premium: | $28.00 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $28.00 |
| Drug Deductible: | $435.00 |
| Tiers with No Deductible: | 0 |
| Benchmark: | below the regional benchmark |
| Type of Medicare Health Plan: | Defined Standard Benefit |
| Drug Benefit Type: | Basic |
| Full LIS Premium: | $0.00 |
| 75% LIS Premium: | $7.00 |
| 50% LIS Premium: | $14.00 |
| 25% LIS Premium: | $21.00 |
| Gap Coverage: | No |
Gap Coverage
In 2020 once you and your plan provider have spent $4020 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for brand-name drugs and 25% on generic drugs unless your plan offers additional coverage. This UnitedHealthcare plan does not offer additional coverage through the gap.
UnitedHealthcare Drug Coverage and Formulary
A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 UnitedHealthcare Dual Complete (PPO D-SNP) H0271-005 Formulary Best uses for evernote. here.
See the 2020 UnitedHealthcare Formulary
(*2020 Plan services will be added when available)
Health plan deductible
Dual Copay Coverage
| $0 |
|---|
Emergency care/Urgent care
| Emergency | $0 copay |
|---|---|
| Urgent care | $0 copay |
Diagnostic procedures/lab services/imaging
| Diagnostic tests and procedures | Out-of-Network | 30% |
|---|---|---|
| Diagnostic tests and procedures | In-Network | $0 copay |
| Lab services | Out-of-Network | $0 copay |
| Lab services | In-Network | $0 copay |
| Diagnostic radiology services (e.g., MRI) | Out-of-Network | 30% |
| Diagnostic radiology services (e.g., MRI) | In-Network | $0 copay |
| Outpatient x-rays | Out-of-Network | 30% |
| Outpatient x-rays | In-Network | $0 copay |
Hearing
| Hearing exam | Out-of-Network | 30% |
|---|---|---|
| Hearing exam | In-Network | $0 copay |
| Fitting/evaluation | Not covered | |
| Hearing aids | Out-of-Network | $0 copay |
| Hearing aids | In-Network | $0 copay |
Dual Company Website
Preventive dental
| Oral exam | Out-of-Network | $0 copay |
|---|---|---|
| Oral exam | In-Network | $0 copay |
| Cleaning | Out-of-Network | $0 copay |
| Cleaning | In-Network | $0 copay |
| Fluoride treatment | Out-of-Network | $0 copay |
| Fluoride treatment | In-Network | $0 copay |
| Dental x-ray(s) | Out-of-Network | $0 copay |
| Dental x-ray(s) | In-Network | $0 copay |
Comprehensive dental
| Non-routine services | Not covered | |
|---|---|---|
| Diagnostic services | Out-of-Network | $0 copay |
| Diagnostic services | In-Network | $0 |
| Restorative services | Out-of-Network | $0 copay |
| Restorative services | In-Network | $0 |
| Endodontics | Out-of-Network | $0 copay |
| Endodontics | In-Network | $0 |
| Periodontics | Out-of-Network | $0 copay |
| Periodontics | In-Network | $0 |
| Extractions | Out-of-Network | $0 copay |
| Extractions | In-Network | $0 |
| Prosthodontics, other oral/maxillofacial surgery, other services | Out-of-Network | $0 copay |
| Prosthodontics, other oral/maxillofacial surgery, other services | In-Network | $0 |
Vision
| Routine eye exam | Out-of-Network | 30% |
|---|---|---|
| Routine eye exam | In-Network | $0 |
| Other | Not covered | |
| Contact lenses | Out-of-Network | 30% |
| Contact lenses | In-Network | $0 copay |
| Eyeglasses (frames and lenses) | Out-of-Network | 30% |
| Eyeglasses (frames and lenses) | In-Network | $0 copay |
| Eyeglass frames | Not covered | |
| Eyeglass lenses | Not covered | |
| Upgrades | Not covered |
Mental health services
| Inpatient hospital - psychiatric | Out-of-Network | 30% per stay |
|---|---|---|
| Inpatient hospital - psychiatric | In-Network | $0 copay |
| Outpatient group therapy visit with a psychiatrist | Out-of-Network | 30% |
| Outpatient group therapy visit with a psychiatrist | In-Network | $0 copay |
| Outpatient individual therapy visit with a psychiatrist | Out-of-Network | 30% |
| Outpatient individual therapy visit with a psychiatrist | In-Network | $0 copay |
| Outpatient group therapy visit | Out-of-Network | 30% |
| Outpatient group therapy visit | In-Network | $0 copay |
| Outpatient individual therapy visit | Out-of-Network | 30% |
| Outpatient individual therapy visit | In-Network | $0 copay |
Skilled Nursing Facility
| Out-of-Network | 30% per stay |
|---|---|
| In-Network | $0 copay |
Rehabilitation services
| Occupational therapy visit | Out-of-Network | 30% |
|---|---|---|
| Occupational therapy visit | In-Network | $0 copay |
| Physical therapy and speech and language therapy visit | Out-of-Network | 30% |
| Physical therapy and speech and language therapy visit | In-Network | $0 copay |
Ground ambulance
| Out-of-Network | 20% |
|---|---|
| In-Network | $0 copay |
Other health plan deductibles?
| In-Network | No |
|---|
Transportation
| Out-of-Network | 75% |
|---|---|
| In-Network | $0 copay |
Foot care (podiatry services)
| Foot exams and treatment | Out-of-Network | 30% |
|---|---|---|
| Foot exams and treatment | In-Network | $0 copay |
| Routine foot care | Out-of-Network | 30% |
| Routine foot care | In-Network | $0 |
Medical equipment/supplies
| Durable medical equipment (e.g., wheelchairs, oxygen) | Out-of-Network | 30% per item |
|---|---|---|
| Durable medical equipment (e.g., wheelchairs, oxygen) | In-Network | $0 copay |
| Prosthetics (e.g., braces, artificial limbs) | Out-of-Network | 30% per item |
| Prosthetics (e.g., braces, artificial limbs) | In-Network | $0 copay |
| Diabetes supplies | Out-of-Network | 30% per item |
| Diabetes supplies | In-Network | $0 copay |
Wellness programs (e.g., fitness, nursing hotline)
| Covered |
|---|
Medicare Part B drugs
| Chemotherapy | Out-of-Network | 20% |
|---|---|---|
| Chemotherapy | In-Network | $0 copay |
| Other Part B drugs | Out-of-Network | 20% |
| Other Part B drugs | In-Network | $0 copay |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $10,000 In and Out-of-network $6,700 In-network |
|---|
Optional supplemental benefits
| No |
|---|
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network | No |
|---|
Inpatient hospital coverage
| Out-of-Network | 30% per stay |
|---|---|
| In-Network | $0 copay |
Outpatient hospital coverage
| Out-of-Network | 30% per visit |
|---|---|
| In-Network | $0 copay |
Doctor visits
| Primary | Out-of-Network | 30% per visit |
|---|---|---|
| Primary | In-Network | $0 copay |
| Specialist | Out-of-Network | 30% per visit |
| Specialist | In-Network | $0 copay |
Dual Copay Form
Preventive care
| Out-of-Network | 0-30% |
|---|---|
| In-Network | $0 copay |
Coverage Area for UnitedHealthcare Dual Complete (PPO D-SNP)
| State: | Indiana |
|---|---|
| County: | Adams, Allen, Bartholomew, Benton, Blackford, Boone, Brown, Carroll, Cass, Clark, Clay, Clinton, Crawford, Daviess, De Kalb, Dearborn, Decatur, Delaware, Dubois, Elkhart, Fayette, Floyd, Fountain, Franklin, Fulton, Gibson, Grant, Greene, Hamilton, Hancock, Harrison, Hendricks, Henry, Howard, Huntington, Jackson, Jasper, Jay, Jefferson, Jennings, Johnson, Knox, Kosciusko, La Porte, Lagrange, Lake, Lawrence, Madison, Marion, Marshall, Martin, Miami, Monroe, Montgomery, Morgan, Newton, Noble, Ohio, Orange, Owen, Parke, Perry, Pike, Porter, Posey, Pulaski, Putnam, Randolph, Ripley, Rush, Scott, Shelby, Spencer, St. Joseph, Starke, Steuben, Sullivan, Switzerland, Tippecanoe, Tipton, Union, Vanderburgh, Vermillion, Vigo, Wabash, Warren, Warrick, Washington, Wells, White, Whitley, |
Dual Eligible Prescription Copay
Source: CMS.
Plans as of September 4, 2019.
Dual Copay Rates
Star Rating as of October 11, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change. All contracts for 2020 have not been finalized. For 2020, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.
Dual Copay Rates
Includes 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.