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.comUnitedHealthcare 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.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,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): 24,875 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 ...A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244o 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 NumberNumber 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 ...2022 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO D-SNP) Location: Pulaski, 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.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.VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2.Y0066_EOC_H0169_002_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 2023 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: 20230218034507Z Vendor Information UnitedHealthcare Dual Complete® (HMO-POS D-SNP) Take advantage of your additional plan benefits by using the providers below or contacting2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0169-002-000 Subject UnitedHealthcare Dual Complete additional benefit overview for health care professionals. 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. TierFeb 22, 2011 · Medicare Advantage & Other Health Plans in Iowa 2023 Iowa Insurance Division 1963 Bell Ave, Suite 100, Des Moines, IA 50315 1-800-351-4664 TTY 1-800-735-2942 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.A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244Learn more about the UnitedHealthcare Dual Complete® Select (HMO-POS D-SNP) H0169-006-000 plan for Nebraska. Check eligibility, explore benefits, and enroll today. VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2.2023 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 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits Details 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,Y0066_EOC_H0169_004_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 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_MVDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2.2023 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 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. 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 UHCCommunityPlan.com Y0066_SB_H0169_002_000_2023_M2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Star Rating Details Y0066_ANOC_H0169_002_000_2023_SP_M. Y0066_210610_INDOI_C Encuentre las actualizaciones de su plan para el próximo añoH0169-002-000 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. ...Introduction If you have a medical emergency, get help as quickly as possible. Call 911 or go to the nearest emergency room or hospital. Emergency care can always be obtained in or out of the service area2022 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) Location: Butler, Nebraska Click to see other locations. Plan ID: H0169 - 003 - 0 Click to see other plans. Member Services: 1-844-368-7149 TTY users 711. 2022 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) Location: Butler, Nebraska Click to see other locations. Plan ID: H0169 - 003 - 0 Click to see other plans. Member Services: 1-844-368-7149 TTY users 711. 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 ¨ Femenino2021 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: 2020Sep 26, 2022 · 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_M 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. Feb 22, 2011 · Medicare Advantage & Other Health Plans in Iowa 2023 Iowa Insurance Division 1963 Bell Ave, Suite 100, Des Moines, IA 50315 1-800-351-4664 TTY 1-800-735-2942 Y0066_EOC_H0169_002_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2. 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. TierA federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244 H0169-002-000 MO99MODSNPF MO99MODSNPP MO99MODSNPQ ... H0169-008-000 MO99MODSNP3F MO99MODSNP3P MO99MODSNP3Q UnitedHealthcare Dual Complete® Choice (PPO D-SNP)Learn more about the UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H0169-002-000 plan for Missouri. Check eligibility, explore benefits, and enroll today.Number of Members enrolled in this plan in (H0169 - 001): 14,992 members : Plan’s Summary Star Rating: 5 out of 5 Stars. This plan qualifies for the 5-star rating Special Enrollment period. Read more. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 5 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars.VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2.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 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 ¨ FemeninoA federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2.Y0066_EOC_H0169_002_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits ExplainedUnitedHealthcare 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.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 ¨ Femenino 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 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 H0169-002-000Emergency care/Urgent care. • Emergency: $0 or $90 copay per visit (always covered) • Urgent care: $0 or $65 copay per visit (always covered) Inpatient hospital coverage. • In 2020 the amounts for each benefit period are $0 or: $1,408 deductible for days 1 through 60. $352 copay per day for days 61 through 90. 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 MO HMO UnitedHealthcare Dual Complete Dual Neither H0169-003-000 NE HMO UnitedHealthcare Dual Complete Dual Neither H0169-004-000 KS HMOPOS UnitedHealthcare Dual Complete LP1 Dual Neither H0251-002-000 TN HMO UnitedHealthcare Dual Complete Dual NeitherUnitedHealthcare 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. VDOMDHTMLad>. 301 Moved Permanently. 301 Moved Permanently. Microsoft-Azure-Application-Gateway/v2. 2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits Details 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.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. 2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits Details 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 ...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 UHCCommunityPlan.com Y0066_SB_H0169_002_000_2023_MUnitedHealthcare Community PlanUnitedHealthcare Dual Complete (HMO-POS D-SNP) H0169-002-000 2023 Plan Details and Costs Learn More about UnitedHealthcare UnitedHealthcare Dual Complete (HMO-POS D-SNP) Plan Details, including how much you can expect to pay for coinsurance, deductibles, premiums and copays for various services covered by the plan. 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_MY0066_EOC_H0169_002_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage 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.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, Learn more about the UnitedHealthcare Dual Complete® Select (HMO-POS D-SNP) H0169-006-000 plan for Nebraska. Check eligibility, explore benefits, and enroll today.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. ...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 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- 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. 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.2022 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete (HMO D-SNP) Location: Pulaski, 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.Sep 26, 2022 · 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_M A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244 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 H0169-002-0002023 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 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. Vendor Information UnitedHealthcare Dual Complete® (HMO-POS D-SNP) Take advantage of your additional plan benefits by using the providers below or contacting Y0066_EOC_H0169_004_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage
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. Stick on fireplace tiles bandq
H0169-002-000 MO HMO UnitedHealthcare Dual Complete Dual Neither H0169-003-000 NE HMO UnitedHealthcare Dual Complete Dual Neither H0169-004-000 KS HMOPOS UnitedHealthcare Dual Complete LP1 Dual Neither H0251-002-000 TN HMO UnitedHealthcare Dual Complete Dual Neither2022 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Star Rating DetailsY0066_EOC_H0169_004_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of CoverageThe UnitedHealthcare Dual Complete (HMO D-SNP) (H0169 - 002) currently has 24,875 members. There are 168 members enrolled in this plan in Barry, Missouri, and 24,793 members in Missouri. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4.5 stars. The detail CMS plan carrier ratings are as follows: 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.H0169-008-000 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_MH0169-002 -000 Monthly premium: $ 0.00 * * Your costs may be as low as $0, depending on your level of Medicaid eligibility. Our plan is a Medicare Advantage HMO Plan (HMO stands for Health Maintenance Organization) with a Point-of-Service (POS) option approved by Medicare and run by a private company. 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 ¨ Femenino2020 UnitedHealthcare Dual Complete (HMO D-SNP) - H0169-002-0 in MO Plan Benefits DetailsThe 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.Emergency care/Urgent care. • Emergency: $0 or $90 copay per visit (always covered) • Urgent care: $0 or $65 copay per visit (always covered) Inpatient hospital coverage. • In 2020 the amounts for each benefit period are $0 or: $1,408 deductible for days 1 through 60. $352 copay per day for days 61 through 90. Y0066_EOC_H0169_004_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage H0169-002-000 MO99MODSNPF MO99MODSNPP MO99MODSNPQ ... H0169-008-000 MO99MODSNP3F MO99MODSNP3P MO99MODSNP3Q UnitedHealthcare Dual Complete® Choice (PPO D-SNP)Y0066_EOC_H0169_002_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage002 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 ...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 ¨ Femenino Y0066_EOC_H0169_001_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage.