Medicare Advantage Plan

Medicare-Eligible Members

MCHCP offers the UnitedHealthcare (UHC) Group Medicare Advantage (PPO) plan for your medical coverage.

The word “Group” means that UHC designed this plan just for MCHCP. Only Medicare-eligible MCHCP members can be in this plan.

“Medicare Advantage” is also known as Medicare Part C. Medicare Advantage has all the benefits of Medicare Part A (hospital coverage) and Medicare Part B (health care provider and outpatient care), plus extra programs that go beyond Original Medicare (Medicare Parts A and B).

Below is a short description of some of the Medicare Advantage Plan benefits. Refer to your UnitedHealthcare (UHC) information packet (including the UHC Annual Notice of Changes) or contact UHC for additional benefit information.

Medical Plans Overview

Plan Cost	Member Responsibility
Annual medical deductible	$275
Annual out-of-pocket maximum	$1,500

Medical Benefits - Medical benefits covered by the plan and Original Medicare

Medical Benefits - Medical benefits covered by the plan and Original Medicare
Service Type	Member Responsibility
Health care provider's office visit	$15 Primary care provider (PCP)$0 Virtual health care provider visits$30 Specialist
Preventive services	Medicare-covered $0 copay
Inpatient hospital care	$150 copay per stay
Outpatient surgery	$100 copay
Skilled nursing facility (SNF)	$0 copay, Days 1-100
Outpatient rehabilitation - Physical, occupational, or speech/language therapy	$30 copay
Mental health - Outpatient and virtual	$30 copay - Group therapy $30 copay - Individual therapy $30 copay - Virtual visits
Diagnostic radiology services such as MRIs, CT scans	$30 copay
Lab services	$0 copay
Outpatient x-rays	$25 copay
Therapeutic radiology services such as radiation treatment for cancer	$30 copay
Ambulance	$100 copay
Emergency care	$100 copay (worldwide)
Urgently needed services	$50 copay (worldwide)

Additional benefits and programs not covered by Original Medicare

Additional benefits and programs not covered by Original Medicare
Service Type	Member Responsibility
Routine physical	$0 copay, 1 per plan year
Medicare-covered chiropractic care (manual manipulation of the spine to correct subluxation)	$20 copay
Chiropractic - routine	$0 copay, Unlimited visits per year
Foot care - routine	$0 copay, Up to 6 visits per year
Hearing - routine exam	$0 copay, 1 per plan year
Hearing aids UnitedHealthcare Hearing	Plan pays through UnitedHealthcare Hearing (combined for both ears) for hearing aids every two years
Vision - routitine eye exam	$0 copay, 1 exam every 12 months
Fitness program Renew Active	$0 copay for a standard gym membership at participating locations
Virtual Health Care Provider Visits	Talk with a health care provider about medical concerns using your computer, tablet or smartphone - anytime, day or night. $0 virtual visits with Amwell and Doctors on Demand $0 virtual and phone visits with Teladoc

Missouri state law, Section 191.724, RSMo, allows a person the right to decline or refuse coverage for contraception if these items or procedures are contrary to an employee’s religious beliefs or moral convictions.

Medicare Advantage Plan

Medical Plans Overview

Medical Benefits - Medical benefits covered by the plan and Original Medicare

Additional benefits and programs not covered by Original Medicare

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