H0169 002 - The UnitedHealthcare Dual Complete (HMO SNP) (H0169 - 002) currently has 8,801 members. There are 28 members enrolled in this plan in Barry, Missouri, and 8,695 members in Missouri. Prescription Drug Coverage: Deductible, Cost-sharing, Formulary: This plan has a $415 deductible. So, you are 100% responsible for the first $415 in medication costs.

 
Vendor Information UnitedHealthcare Dual Complete® (HMO-POS D-SNP) Take advantage of your additional plan benefits by using the providers below or contacting. P gioioso and sons inc

H0169-002-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.comH0169-002-000 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. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H0169_002_000_2023_MH0169-002-000 CMS Rating 4.5 out of 5 stars. Monthly premium: $ 0.00 * * Your costs may be as low as $0, depending on your level of Medicaid eligibility. ...Vendor Information UnitedHealthcare Dual Complete® (HMO-POS D-SNP) Take advantage of your additional plan benefits by using the providers below or contacting Jan 1, 2023 · Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 Service area: Missouri - Adair, Andrew, Atchison, Audrain, Barry, Barton, Bates, Benton, Bollinger, UnitedHealthcare Community Plan Number of Members enrolled in this plan in (H0169 - 002): 38,511 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: Insufficient data to rate this plan. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split ...Number of Members enrolled in this plan in (H0169 - 002): 38,511 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: Insufficient data to rate this plan. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split ...H0169-002-000 CMS Rating 4.5 out of 5 stars. Monthly premium: $ 0.00 * * Your costs may be as low as $0, depending on your level of Medicaid eligibility. ...4.5 out of 5 stars* for plan year 2023. $0.00 Monthly Premium. UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0169-002-000.Jan 1, 2023 · H0169-004-000 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. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H0169_004_000_2023_M H0169-008-000 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. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H0169_008_000_2023_MNumber of Members enrolled in this plan in (H0169 - 002): 14,549 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...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 $4000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined.UnitedHealthcare Dual Complete® (HMO-POS D-SNP) UnitedHealthcare Dual Complete® Select (HMO-POS D-SNP) Complete Drug List (Formulary) 2023 Important notes: This document has information about the drugs covered by this plan. We would like to show you a description here but the site won’t allow us.o UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 - UD5 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 ¨ Femeninoo UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 - UD5 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 Number2018 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. Y0066_ANOC_H0169_002_000_2023_M. Y0066_210610_INDOI_C Find updates to your plan for next year This notice provides information about updates to your plan, but it ... 2021 UnitedHealthcare (H0169) Star Rating Details; UnitedHealthcare Dual Complete (HMO D-SNP) (H0169-002-0) Benefit Details The UnitedHealthcare Dual Complete (HMO D-SNP) (H0169-002-0) in Lafayette, MO: CMS MA Region 15 which includes: MO Plan Monthly Premium: $30.50 Deductible: $445: Star Rating Category & Measures: 2021: 20202022 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits DetailsVDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2.8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H0169_002_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 complete list of covered services, limitations and exclusions.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 $4000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined.o UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 - UD5 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 NumberY0066_EOC_H0169_002_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of CoverageH0169-002-000 MO99MODSNPF MO99MODSNPP MO99MODSNPQ ... H0169-008-000 MO99MODSNP3F MO99MODSNP3P MO99MODSNP3Q UnitedHealthcare Dual Complete® Choice (PPO D-SNP) Aug, 18 2023 — Based on the 2024 Medicare Part D plan bids and June plan enrollment, the 2024 average total Part D premium is projected to be $55.50 per month, a decrease of 1.8 percent from the 2023 average total premium of $56.49.2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0169-002-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0169-008-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-029-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H0169-002-000 Y0066_ANOC_H0169_002_000_2023_M. Y0066_210610_INDOI_C Find updates to your plan for next year This notice provides information about updates to your plan, but it ... Number of Members enrolled in this plan in (H0169 - 002): 14,549 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...Number of Members enrolled in this plan in (H0169 - 002): 14,549 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...H0169-004-000 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. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H0169_004_000_2023_Mo UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 - UD5 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 2018 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.H0169-002-000 MO99MODSNPF MO99MODSNPP MO99MODSNPQ ... H0169-008-000 MO99MODSNP3F MO99MODSNP3P MO99MODSNP3Q UnitedHealthcare Dual Complete® Choice (PPO D-SNP)UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 plans for Missouri and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools.The UnitedHealthcare Dual Complete (HMO D-SNP) (H0169 - 001) currently has 14,992 members. There are 15 members enrolled in this plan in Hancock, Iowa, and 14,934 members in Iowa. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 5 stars.We would like to show you a description here but the site won’t allow us.Y0066_ANOC_H0169_002_000_2023_M. Y0066_210610_INDOI_C Find updates to your plan for next year This notice provides information about updates to your plan, but it ...The UnitedHealthcare Dual Complete (HMO D-SNP) (H0169 - 002) currently has 18,440 members. There are 286 members enrolled in this plan in St. Francois, Missouri, and 18,325 members in Missouri. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 5 stars.Guía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 Área de servicio: Missouri - condados de Adair, Andrew, Atchison, Audrain, Barry, Barton, Bates,1 2022 Summary of Benefits BlueMedicare Saver Choice (PPO) H3554-002 The service area for BlueMedicare Saver Choice (PPO) includes the following Arkansas counties: Ashley, Baxter, Benton, Boone, Carroll, Clark, Clay, Columbia, Craighead, Crawford, Crittenden,Number of Members enrolled in this plan in (H0169 - 002): 38,511 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: Insufficient data to rate this plan. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split ... 2023 Evidence of Coverage for UnitedHealthcare Dual Complete® LP (HMO-POS D-SNP) Table of Contents Questions? Call Customer Service at 1-866-842-4968, TTY 711, 8am-8pm: 7 Days Oct- The UnitedHealthcare Dual Complete (HMO D-SNP) (H0169 - 002) currently has 18,440 members. There are 455 members enrolled in this plan in Clay, Missouri, and 18,325 members in Missouri. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 5 stars.1 2022 Summary of Benefits BlueMedicare Saver Choice (PPO) H3554-002 The service area for BlueMedicare Saver Choice (PPO) includes the following Arkansas counties: Ashley, Baxter, Benton, Boone, Carroll, Clark, Clay, Columbia, Craighead, Crawford, Crittenden,002 hamaspik, inc. fide 001 ny h0111 004 wellcare of georgia, inc. ga h0154 012 viva health, inc. al 019 h0169 unitedhealthcare of the midwest, inc. ia ks hide 003 h0174 wellcare of texas, inc. 006 h0251 005 unitedhealthcare plan of the river valley, inc. tn h0270 wellcare health insurance company of america ar h0271 023 014 ct in me 020 028 mi ... UnitedHealthcare Community Plan H0169-002-000 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. Toll-free 1-844-560-4944, TTY 711 8 a.m. - 8 p.m. local time, 7 days a week www.UHCCommunityPlan.com Y0066_SB_H0169_002_000_2022_M. www.UHCCommunityPlan.comY0066_EOC_H0169_002_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits Details Medicare options – Missouri only unless stated otherwise. Medicare – Medicare Part B (called traditional Medicare) is managed by the government agency called Centers for Medicare and Medicaid Services or CMS. This plan issues a red, white and blue enrollment card. For information or to enroll call 800-633-4227.H0169-002-000 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. Toll-free 1-844-560-4944, TTY 711 8 a.m. - 8 p.m. local time, 7 days a week www.UHCCommunityPlan.com Y0066_SB_H0169_002_000_2022_M. www.UHCCommunityPlan.comNumber of Members enrolled in this plan in (H0169 - 002): 38,511 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: Insufficient data to rate this plan. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split ...The UnitedHealthcare Dual Complete (HMO SNP) (H0169 - 002) currently has 8,801 members. There are 28 members enrolled in this plan in Barry, Missouri, and 8,695 members in Missouri. Prescription Drug Coverage: Deductible, Cost-sharing, Formulary: This plan has a $415 deductible. So, you are 100% responsible for the first $415 in medication costs.Number of Members enrolled in this plan in (H0169 - 002): 38,511 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: Insufficient data to rate this plan. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split ...UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-001-000 plans for Iowa and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools.As an Arkansas Blue Medicare member, you’ll be eligible to earn valuable rewards for getting exams, preventive screenings, tests and completing other health-related activities. Comprehensive dental benefits. $0 copay for 1 routine hearing exam per year. $699/$999 copay per hearing aid (2 per year) Please see plan documents for more details. Learn more about the UnitedHealthcare Dual Complete® Select (HMO-POS D-SNP) H0169-008-000 plan for Missouri. Check eligibility, explore benefits, and enroll today.2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0169-002-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0169-008-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-029-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H0169-002-000 Y0066_ANOC_H0169_002_000_2023_M. Y0066_210610_INDOI_C Find updates to your plan for next year This notice provides information about updates to your plan, but it ... UnitedHealthcare Dual Complete (HMO-POS D-SNP) 4.5 out of 5 stars. UnitedHealthcare Dual Complete (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0169-002. $ 0.00.UnitedHealthcare Dual Complete (HMO D-SNP) (H0169-002-0) Sanctioned Plan The UnitedHealthcare Dual Complete (HMO D-SNP) (H0169-002-0) Formulary Drugs Starting with the Letter A in Howard County, MO: CMS MA Region 15 which includes: MO: Drugs Starting with Letter A Drug Name Drug Tier Information Cost-Sharing Drug Usage Mgmt; Tier Nbr. TierUnitedHealthcare Dual Complete (HMO D-SNP) (H0169-002-0) Sanctioned Plan The UnitedHealthcare Dual Complete (HMO D-SNP) (H0169-002-0) Formulary Drugs Starting with the Letter A in Howard County, MO: CMS MA Region 15 which includes: MO: Drugs Starting with Letter A Drug Name Drug Tier Information Cost-Sharing Drug Usage Mgmt; Tier Nbr. Tier 002 hamaspik, inc. fide 001 ny h0111 004 wellcare of georgia, inc. ga h0154 012 viva health, inc. al 019 h0169 unitedhealthcare of the midwest, inc. ia ks hide 003 h0174 wellcare of texas, inc. 006 h0251 005 unitedhealthcare plan of the river valley, inc. tn h0270 wellcare health insurance company of america ar h0271 023 014 ct in me 020 028 mi ... 2021 Medicare Advantage Plan Benefit Details for the UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans. 002 hamaspik, inc. fide 001 ny h0111 004 wellcare of georgia, inc. ga h0154 012 viva health, inc. al 019 h0169 unitedhealthcare of the midwest, inc. ia ks hide 003 h0174 wellcare of texas, inc. 006 h0251 005 unitedhealthcare plan of the river valley, inc. tn h0270 wellcare health insurance company of america ar h0271 023 014 ct in me 020 028 mi ...2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits Explained2023 Missouri UnitedHealthcare Dual Complete® Plan Frequently Asked Questions: H0169-002-000 Subject: UnitedHealthcare Community Plan of Missouri manages the Medicare Advantage benefits and reimburses you according to your existing contracted rates. Created Date: 20230218034507ZUnitedHealthcare Dual Complete® (HMO-POS D-SNP) UnitedHealthcare Dual Complete® Select (HMO-POS D-SNP) Complete Drug List (Formulary) 2023 Important notes: This document has information about the drugs covered by this plan. H0169-002-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com Jan 1, 2023 · H0169-001-000 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. Toll-free 1-844-560-4944, TTY 711 8 a.m.-8 p.m. local time, 7 days a week UHCCommunityPlan.com Y0066_SB_H0169_001_000_2023_M UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP) covers a range of additional benefits. Learn more about UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP) benefits, some of which may not be covered by Original Medicare (Part A and Part B). Diabetes supplies, training, nutrition therapy and monitoring. We would like to show you a description here but the site won’t allow us.VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2. H0169-002-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que proporciona el plan. Llame a Servicio al Cliente o visite el sitio web para obtener más información sobre el plan. Llamada gratuita 1-844-560-4944, TTY 711 8 a.m. a 8 p.m., hora local, los 7 días de la semana UHCCommunityPlan.com2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits Explained2021 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO D-SNP) Location: Jackson, Missouri Click to see other locations. Plan ID: H0169 - 002 - 0 Click to see other plans. Member Services: 1-844-368-6886 TTY users 711.2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0169-002-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0169-008-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-029-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H0169-002-000The UnitedHealthcare Dual Complete (HMO D-SNP) (H0169 - 001) currently has 14,992 members. There are 15 members enrolled in this plan in Hancock, Iowa, and 14,934 members in Iowa. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 5 stars. Y0066_ANOC_H0169_002_000_2023_M. Y0066_210610_INDOI_C Find updates to your plan for next year This notice provides information about updates to your plan, but it ...

o UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 - UD5 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 Number. Hp 17.3

h0169 002

Number of Members enrolled in this plan in (H0169 - 004): 1,480 members : Plan’s Summary Star Rating: 4.5 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 4 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2.As an Arkansas Blue Medicare member, you’ll be eligible to earn valuable rewards for getting exams, preventive screenings, tests and completing other health-related activities. Comprehensive dental benefits. $0 copay for 1 routine hearing exam per year. $699/$999 copay per hearing aid (2 per year) Please see plan documents for more details.Y0066_EOC_H0169_002_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverageo UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 - UD5 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 NumberUnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 plans for Missouri and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.2019 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.Y0066_EOC_H0169_002_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of CoverageA federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244Medicare options – Missouri only unless stated otherwise. Medicare – Medicare Part B (called traditional Medicare) is managed by the government agency called Centers for Medicare and Medicaid Services or CMS. This plan issues a red, white and blue enrollment card. For information or to enroll call 800-633-4227. 1 2022 Summary of Benefits BlueMedicare Saver Choice (PPO) H3554-002 The service area for BlueMedicare Saver Choice (PPO) includes the following Arkansas counties: Ashley, Baxter, Benton, Boone, Carroll, Clark, Clay, Columbia, Craighead, Crawford, Crittenden,2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits Explained2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits Explained 2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits Details2022 Medicare Advantage Plan Benefit Details for the UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans. o UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 - UD5 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 NumberUnitedHealthcare Dual Complete (HMO D-SNP) (H0169-002-0) Sanctioned Plan The UnitedHealthcare Dual Complete (HMO D-SNP) (H0169-002-0) Formulary Drugs Starting with the Letter A in Howard County, MO: CMS MA Region 15 which includes: MO: Drugs Starting with Letter A Drug Name Drug Tier Information Cost-Sharing Drug Usage Mgmt; Tier Nbr. Tier The UnitedHealthcare Dual Complete LP1 (HMO-POS 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. .

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