UHC Canopy Health Medicare Advantage CA-013P (HMO-POS)

H0543 - 209 - 0
3.5 out of 5 stars (3.5 / 5)

UHC Canopy Health Medicare Advantage CA-013P (HMO-POS) is a Medicare Advantage Plan by UnitedHealthcare.

This page features plan details for 2024 UHC Canopy Health Medicare Advantage CA-013P (HMO-POS) H0543 – 209 – 0 available in Santa Cruz County.

IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:

No 2025 version found. You can use the location links below to find 2025 plans in your area.

Locations

UHC Canopy Health Medicare Advantage CA-013P (HMO-POS) is offered in the following locations.

Plan Overview

UHC Canopy Health Medicare Advantage CA-013P (HMO-POS) offers the following coverage and cost-sharing.

Insurer:UnitedHealthcare
Health Plan Deductible:$0.00
MOOP:$3,400 In-network
Drugs Covered:Yes

Ready to sign up for UHC Canopy Health Medicare Advantage CA-013P (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

UHC Canopy Health Medicare Advantage CA-013P (HMO-POS) has a monthly premium of $46.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$174.70 $4.70 $41.30 $0.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

UHC Canopy Health Medicare Advantage CA-013P (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:$0.00
Initial Coverage Limit:$5,030.00
Catastrophic Coverage Limit:$8,000.00
Drug Benefit Type:Enhanced Alternative
Additional Gap Coverage:Yes
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$41.30$

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

Tier Cost
All other tiers (Generic)25%
All other tiers (Brand-name)25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

UHC Canopy Health Medicare Advantage CA-013P (HMO-POS) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$3,400 In-network

Optional supplemental benefits

No

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network No

Outpatient hospital coverage

In-network $0-220 copay per visit (Authorization is required.) (Referral is required.)

Doctor visits

In-network Primary$0 copay (Not applicable.) (Not applicable.)
In-network Specialist$0-20 copay per visit (Authorization is required.) (Referral is required.)

Preventive care

In-network $0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$135 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$0-40 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures$0 copay (Authorization is required.) (Referral is required.)
In-network Lab services$0 copay (Authorization is required.) (Referral is required.)
In-network Diagnostic radiology services (e.g., MRI)$0-150 copay (Authorization is required.) (Referral is required.)
In-network Outpatient x-rays$25 copay (Authorization is required.) (Referral is required.)

Hearing

In-network Hearing exam$0 copay (Authorization is required.) (Referral is required.)
Fitting/evaluationNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Hearing aids$99-1,249 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Preventive dental

In-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

In-network Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is required.)
out-of-network Non-routine services0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
In-network Diagnostic services$0 copay (Limits may apply.) (Authorization is required.) (Referral is required.)
out-of-network Diagnostic services0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
In-network Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is required.)
out-of-network Restorative services0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
In-network Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is required.)
out-of-network Endodontics0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
In-network Periodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is required.)
out-of-network Periodontics0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
In-network Extractions$0 copay (Limits may apply.) (Authorization is required.) (Referral is required.)
out-of-network Extractions0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
In-network Prosthodontics, other oral/maxillofacial surgery, other services0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
out-of-network Prosthodontics, other oral/maxillofacial surgery, other services0-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)

Vision

In-network Routine eye exam$0 copay (Limits may apply.) (Authorization is required.) (Referral is required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is required.)
In-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is required.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

In-network Occupational therapy visit$0-20 copay (Authorization is required.) (Referral is required.)
In-network Physical therapy and speech and language therapy visit$0-20 copay (Authorization is required.) (Referral is required.)

Ground ambulance

In-network $290 copay (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

In-network Foot exams and treatment$20 copay (Authorization is required.) (Referral is required.)
In-network Routine foot care$20 copay (Limits may apply.) (Authorization is required.) (Referral is required.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Diabetes supplies$0 copay per item (Authorization is required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
In-network Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
In-network Part B Insulin drugs0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

In-network $250 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond (Authorization is required.) (Referral is required.)
out-of-network Not Applicable (Authorization is required.) (Referral is required.)

Mental health services

In-network Inpatient hospital – psychiatric$250 per day for days 1 through 6
$0 per day for days 7 through 90 (Authorization is required.) (Referral is required.)
out-of-network Inpatient hospital – psychiatricNot Applicable (Authorization is required.) (Referral is required.)
In-network Outpatient group therapy visit with a psychiatrist$15 copay (Authorization is required.) (Referral is required.)
In-network Outpatient individual therapy visit with a psychiatrist$0-25 copay (Authorization is required.) (Referral is required.)
In-network Outpatient group therapy visit$15 copay (Authorization is required.) (Referral is required.)
In-network Outpatient individual therapy visit$0-25 copay (Authorization is required.) (Referral is required.)

Skilled Nursing Facility

In-network $0 per day for days 1 through 20
$203 per day for days 21 through 100 (Authorization is required.) (Referral is required.)
out-of-network Not Applicable (Authorization is required.) (Referral is required.)

Ready to sign up for UHC Canopy Health Medicare Advantage CA-013P (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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