H0271 038 - The table below outlines some of the specific plan details for UnitedHealthcare Medicare Advantage plans available in Utah in 2023. Plan Name. Plan Code. Monthly Premium. Deductible. Out of. Pocket Max. Prescription Drug Coverage. Medicare.

 
The UnitedHealthcare Dual Complete Choice (PPO D-SNP) (H0271 - 038) currently has 6,106 members. There are 84 members enrolled in this plan in Iron, Utah. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars. The detail CMS plan carrier ratings are as follows: . Sampercent27s club auburn

The UnitedHealthcare Dual Complete Choice (PPO D-SNP) (H0271 - 038) currently has 6,106 members. There are 135 members enrolled in this plan in Sanpete, Utah. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars. The detail CMS plan carrier ratings are as follows: 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Star Rating DetailsUnitedHealthcare offers UnitedHealthcare Dual Complete® Choice - SH (PPO D-SNP) H0271-038-000 plans for Utah and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.Y0066_ANOC_H0271_038_000_2023_SP_M. Y0066_210610_INDOI_C Encuentre las actualizaciones de su plan para el próximo año2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete Choice (PPO D-SNP) Location: Utah, Utah Click to see other locations. Plan ID: H0271 - 038 - 0 Click to see other plans. Member Services: 1-866-480-1086 TTY users 711.UnitedHealthcare offers UnitedHealthcare Dual Complete® Choice - SH (PPO D-SNP) H0271-038-000 plans for Utah and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools. Y0066_ANOC_H0271_038_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 ...2022 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Plan Benefits DetailsEnrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-038-000 Service area: Utah - Beaver, Box Elder, Cache, Carbon, Davis, Duchesne, Emery, Garfield, Iron, 2022 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Star Rating DetailsWe would like to show you a description here but the site won’t allow us.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 ...The UnitedHealthcare Dual Complete Choice (PPO D-SNP) (H0271 - 038) currently has 6,106 members. There are 84 members enrolled in this plan in Iron, Utah. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars. The detail CMS plan carrier ratings are as follows: Preferred Mail Order Pharmacy. (100 days) $131 copay. Standard Mail Order Pharmacy. (100 days) $141 copay. Tier 3: Select Insulin Drugs. Tier 3: Select Insulin Drugs. For Chronic Special Needs plans: You will pay a maximum of $25 for each 1-month supply of Part D select insulin drug through all coverage stages.Y0066_SB_H0271_038_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 ...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 ...The average monthly premium for Medicare Advantage plans in Salt Lake is $5.83 per month in 2023, though there may be plans available where you live that feature different premiums. Medicare Advantage plans in Salt Lake County have an average Medicare Star Rating of 3.83 in 2023.*. Plans rated four stars or higher are considered top-rated ... 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Star Rating Detailso UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-038-000 - UOS 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 ¨ FemeninoY0066_SB_H0271_033_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 ...2022 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete Choice (PPO D-SNP) Location: Golden Valley, Montana Click to see other locations. Plan ID: H0271 - 030 - 0 Click to see other plans. Member Services: 1-866-480-1086 TTY users 711. o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-038-000 - UOS 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 NumberLearn more about the UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-028-000 plan for Michigan. Check eligibility, explore benefits, and enroll today.The table below outlines some of the specific plan details for UnitedHealthcare Medicare Advantage plans available in Utah in 2023. Plan Name. Plan Code. Monthly Premium. Deductible. Out of. Pocket Max. Prescription Drug Coverage. Medicare. 4 out of 5 stars. UnitedHealthcare Chronic Complete Assure (PPO C-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0271-036. $ 13.30. Monthly Premium.Evidence of Coverage 2023 UnitedHealthcare® Chronic Complete (HMO-POS C-SNP) Toll-free 1-877-370-2843, TTY 711 24 hours a day, 7 days a week myUHCMedicare.com Y0066_EOC_H0609_042_000_2023_CNumber 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 ...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_C Y0066_EOC_H0271_038_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of CoverageLearn more about the UnitedHealthcare Dual Complete® Choice - SH (PPO D-SNP) H0271-038-000 plan for Utah. 00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined. Company: UnitedHealthcare Plan enrollment: 1,007 Total monthly premium: $0 Max annual payment: $10,000 Plan link on ...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.Plan ID: H0271-038-000. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. Utah 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 ...H0271 - 033 - 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 Learn more about the UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-028-000 plan for Michigan. Check eligibility, explore benefits, and enroll today.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. 2022 Medicare Advantage Plan Benefits explained in plain text. Plain text explanation available for any plan in any state. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC and National Insurance Markets, IncLearn more about the UnitedHealthcare Dual Complete® Choice - SH (PPO D-SNP) H0271-038-000 plan for Utah. Check eligibility, explore benefits, and enroll today.A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244Evidence 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_CEnrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-038-000 Service area: Utah - Beaver, Box Elder, Cache, Carbon, Davis, Duchesne, Emery, Garfield, Iron, Activate the column resize button and use the right and left arrow keys to resize a column or use your mouse to drag/resize. Press escape to cancel the resizing. Learn more about the UnitedHealthcare Dual Complete® Choice - SH (PPO D-SNP) H0271-038-000 plan for Utah. 00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined. Company: UnitedHealthcare Plan enrollment: 1,007 Total monthly premium: $0 Max annual payment: $10,000 Plan link on ...2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Star Rating DetailsY0066_EOC_H0271_038_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of CoverageY0066_EOC_H0271_038_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of CoverageEvidence 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_CY0066_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 ...Jan 1, 2023 · Summary of Benefits 2023 UnitedHealthcare® Chronic Complete Assure (PPO C-SNP) H0271-034-000 Look inside to take advantage of the health services and drug coverages the plan provides. 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 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Star Rating Details 2022 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Plan Benefits Details 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.H0271 - 033 - 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 assistanceJan 1, 2023 · Summary of Benefits 2023. UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-038-000. 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. 5. Introduction. SHIBA (Senior Health Insurance Benefits Assistance) is a statewide network of certified . counselors volunteering in their community to help all Oregonians make educatedSummary of Benefits 2023. UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-038-000. 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_ANOC_H0271_038_000_2023_SP_M. Y0066_210610_INDOI_C Encuentre las actualizaciones de su plan para el próximo añoResumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-038-000 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud queEnrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-038-000 Service area: Utah - Beaver, Box Elder, Cache, Carbon, Davis, Duchesne, Emery, Garfield, Iron, 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048. Email a copy of the UnitedHealthcare Dual Complete (PPO SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify for both Medicare and ... Y0066_ANOC_H0271_038_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 Chronic Complete Assure (PPO C-SNP) 4 out of 5 stars. UnitedHealthcare Chronic Complete Assure (PPO C-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare. Plan ID: H0271-027. $ 9.80. Monthly Premium. H0271 - 033 - 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 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_C Learn more about the UnitedHealthcare Dual Complete® Choice - SH (PPO D-SNP) H0271-038-000 plan for Utah. Check eligibility, explore benefits, and enroll today.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 Choice (PPO D-SNP) - H0271-038-0 in UT Star Rating DetailsUtah Health Plans Utah 2023 UnitedHealthcare Dual Complete® Choice - SH (PPO D-SNP) H0271-038-000 Utah 2023 UnitedHealthcare Dual Complete® Choice - SH (PPO D-SNP) H0271-038-000 Steps to Enroll UnitedHealthcare Dual Complete® Choice - SH (PPO D-SNP) Steps to Enroll Steps to an easy enrollment.2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Star Rating DetailsThe UnitedHealthcare Dual Complete Choice (PPO D-SNP) (H0271 - 038) currently has 6,106 members. There are 230 members enrolled in this plan in Washington, Utah. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars. The detail CMS plan carrier ratings are as follows: 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 Medicare Advantage Assure (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $36.00 (see Plan Premium Details below) Annual Deductible: $445. • H0271-038 = Group # 90064/Optum DSNP Choice • H0271-039 = Group # 90065/Optum DSNP Select • H7404-021 = Group # 90034/Optum PPO 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_C2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Plan Benefits DetailsEvidence of Coverage 2023 UnitedHealthcare® Chronic Complete Assure (PPO C-SNP) Toll-free 1-866-579-8774, TTY 711 24 hours a day, 7 days a week myUHCMedicare.com Y0066_EOC_H0271_034_000_2023_CCSUT23PP0049808_000 Página 1 de 8 Solicitud de Inscripción 2023 o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-038-000 - UOS Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-038-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-039-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H0271-038-000; 2023 UnitedHealthcare Dual Complete Plan Frequently Asked Questions H0271-039-000 2022 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete Choice (PPO D-SNP) Location: Golden Valley, Montana Click to see other locations. Plan ID: H0271 - 030 - 0 Click to see other plans. Member Services: 1-866-480-1086 TTY users 711. Y0066_SB_H0271_038_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 ... H0271-022-000 OR Local PPO UnitedHealthcare Medicare Advantage ... H0609-038-000 NV HMO AARP Medicare Advantage Walgreens Plan 1 Not SNP NeitherEnrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-038-000 Service area: Utah - Beaver, Box Elder, Cache, Carbon, Davis, Duchesne, Emery, Garfield, Iron,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 estrellasY0066_ANOC_H0271_038_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 ...Y0066_SB_H0271_038_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 ...Evidence of Coverage 2023 UnitedHealthcare® Chronic Complete (HMO-POS C-SNP) Toll-free 1-877-370-2843, TTY 711 24 hours a day, 7 days a week myUHCMedicare.com Y0066_EOC_H0609_042_000_2023_C Summary of Benefits 2023 UnitedHealthcare® Chronic Complete Assure (PPO C-SNP) H0271-034-000 Look inside to take advantage of the health services and drug coverages the plan provides.Y0066_EOC_H0271_038_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 038 – 0 available in Select Counties in Utah. IMPORTANT : This page has been updated with plan and premium data for 2023.2022 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.

Summary of Benefits 2023. UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-038-000. 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.. How much is dollar30 in robux

h0271 038

h0271-029-000 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 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. Y0066_SB_H0271_033_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_033_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 ...Cost Sharing Plan Information: When a consumer has partial or inactive Medicaid eligibility you must inform the prospective member of the potential co-pay/co-insurance amounts they could incur if they enroll in a cost-sharing plan without having a level of Medicaid that would help cover plan costs.2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete Choice (PPO D-SNP) Location: Utah, Utah Click to see other locations. Plan ID: H0271 - 038 - 0 Click to see other plans. Member Services: 1-866-480-1086 TTY users 711.2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Plan Benefits Details1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048. Email a copy of the UnitedHealthcare Dual Complete (PPO SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify for both Medicare and ... 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_C 2022 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Plan Benefits Details5. Introduction. SHIBA (Senior Health Insurance Benefits Assistance) is a statewide network of certified . counselors volunteering in their community to help all Oregonians make educated 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Plan Benefits Details 2022 UnitedHealthcare Dual Complete Choice (PPO D-SNP) - H0271-038-0 in UT Plan Benefits DetailsPlan 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 ... We would like to show you a description here but the site won’t allow us.Y0066_EOC_H0271_038_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage UnitedHealthcare Dual Complete Choice (PPO D-SNP) in UT - H0271-038-0 Benefits & Contact Info Box Elder: $0.00 for people who qualify for both Medicare and Medicaid. $0 for people who qualify for both Medicare and Medicaid. No additional gap coverage, only the Donut Hole Discount: Tier 1: $0.00 all covered insulin pay $35 or less: n/a.

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