Coverage and benefits
Get a quick overview of the plan benefits and costs and find more detailed information about additional benefits and programs.
Important Information about your Part D Vaccine and Insulin Coverage
What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you.
What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on. You may pay less depending on your plan coverage. Refer to your plan materials.
Compass Rose Medicare Advantage Plan (PPO)
Benefits and costs
|Benefits||Compass Rose Medicare Advantage Plan (PPO)|
|Part B premium reduction||$125 per month|
|Annual medical deductible||None|
|Annual out-of-pocket maximum||None|
|Office and clinic visits||$0 copay for primary care, specialist or Virtual Visit/Telemedicine|
|Hospital services (inpatient)||$0 copay|
|Hospital services (outpatient)||$0 copay|
|Ambulance services||$0 copay|
|Emergency room||$0 copay|
|Urgent care||$0 copay|
|Durable medical equipment||$0 copay|
|Diabetic supplies (test strips, lancets, glucose monitors)||$0 copay|
|Preventive services||$0 copay|
|Routine podiatry||$0 copay - 6 visits per year|
|Massage therapy||$0 copay
$60 allowance per visit
|Hearing aid allowance||
$0 copay - $2,400 allowance for unlimited aids every 3 years. Allowance is combined for both ears.
You must contact UnitedHealthcare hearing prior to using your hearing aid allowance. Hearing aids ordered through providers other than UnitedHealthcare Hearing are not covered.
|Dental||Class 1 Preventive & Diagnostic (P&D): 100%
Class 2 Minor: 80%
Class 3 Major: 50%
Deductible (P&D not included): $50
Annual Calendar Maximum (P&D not included): $1,000
Out-of-network reimbursement schedule: Maximum Allowable Charge
|Vision||Routine Eye Exam Refraction: $0 copay – 1 per 12 months
Eyeglasses Allowance: $130 every 12 months
Contact Lens Allowance (in lieu of glasses): $175 every 12 months
|Prescription drug coverage||
Part D Retail Copay (up to a 30-day supply)
Tier 1: Generic $1 copay
Tier 1: Generic $2 copay
* UnitedHealthcare’s pharmacy benefit manager is OptumRX. Mail order prescriptions will be through OptumRX.
The following preventive services are covered under your plan for a $0 copay when you visit your primary care provider:
- Annual Wellness Exam
- Annual Routine Physical
- Screenings for certain Cancers (Prostate, colorectal, breast cancer)
- Screening for diabetes
- Smoking and Tobacco Use Cessation
For more information about these preventive services, please call the Customer Service number on your member ID card.