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UnitedHealthcare Chronic Complete Assure (PPO C-SNP)

H0271 - 033 - 0
4 out of 5 stars (4 / 5)

UnitedHealthcare Chronic Complete Assure (PPO C-SNP) is a Medicare Advantage Special Needs Plan by UnitedHealthcare.

This page features plan details for 2023 UnitedHealthcare Chronic Complete Assure (PPO C-SNP) H0271 – 033 – 0 available in Select Counties in New Mexico.

IMPORTANT: This page features the 2023 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

UnitedHealthcare Chronic Complete Assure (PPO C-SNP) is offered in the following locations.

Bernalillo County, New Mexico
Los Alamos County, New Mexico
Mora County, New Mexico

Click to see more locations

Plan Overview

UnitedHealthcare Chronic Complete Assure (PPO C-SNP) offers the following coverage and cost-sharing.

Special Needs Plan Type:Chronic or Disabling Condition
Conditions Covered:
  • Cardiovascular Disorders, Chronic Heart Failure and Diabetes
    • Insurer:UnitedHealthcare
    Health Plan Deductible:$233 annual deductible
    MOOP:$12,450 In and Out-of-network
    $8,300 In-network
    Drugs Covered:Yes

    Ready to sign up for UnitedHealthcare Chronic Complete Assure (PPO C-SNP) ?

    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

    UnitedHealthcare Chronic Complete Assure (PPO C-SNP) has a monthly premium of $14.10. 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
    $164.90 $0.00 $14.10 $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

    UnitedHealthcare Chronic Complete Assure (PPO C-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

    Drug Deductible: $505.00
    Initial Coverage Limit: $4,660.00
    Catastrophic Coverage Limit: $7,400.00
    Drug Benefit Type: Basic
    Gap Coverage: No
    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 D LIS 25% LIS 50% LIS 75% LIS Full
    $14.10 $43.40 $34.80 $26.30 $17.70

    Initial Coverage Phase

    After you pay your $505.00 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 $4,660.00. Once you reach that amount, you will enter the next coverage phase.

    Gap Coverage Phase

    Drug TypeCost Share
    Generic drugs25%
    Brand-name drugs25%

    Catastrophic Coverage Phase

    After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

    Drug TypeCost Share
    Generic drugs$4.15 copay or 5% (whichever costs more)
    Brand-name drugs$10.35 copay or 5% (whichever costs more)

    Additional Benefits

    UnitedHealthcare Chronic Complete Assure (PPO C-SNP) also provides the following benefits.

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

    In-Network: No

    Dental (comprehensive)

    Diagnostic services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Diagnostic services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Endodontics:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Endodontics:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Extractions:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Extractions:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Non-routine services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Non-routine services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Periodontics:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Periodontics:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Prosthodontics, other oral/maxillofacial surgery, other services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Prosthodontics, other oral/maxillofacial surgery, other services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Restorative services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Restorative services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)

    Dental (preventive)

    Cleaning:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Cleaning:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Dental x-ray(s):In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Dental x-ray(s):Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Fluoride treatment:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Fluoride treatment:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Oral exam:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Oral exam:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)

    Diagnostic procedures/lab services/imaging

    Diagnostic radiology services (e.g., MRI):In-Network: 0-20% coinsurance (authorization required) (referral not required)
    Diagnostic radiology services (e.g., MRI):Out-of-Network: 30% coinsurance (authorization required) (referral not required)
    Diagnostic tests and procedures:In-Network: 20% coinsurance (authorization required) (referral not required)
    Diagnostic tests and procedures:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
    Lab services:In-Network: $0 copay (authorization required) (referral not required)
    Lab services:Out-of-Network: $0 copay (authorization required) (referral not required)
    Outpatient x-rays:In-Network: 20% coinsurance (authorization required) (referral not required)
    Outpatient x-rays:Out-of-Network: 30% coinsurance (authorization required) (referral not required)

    Doctor visits

    Primary:In-Network: 20% coinsurance per visit
    Primary:Out-of-Network: 30% coinsurance per visit
    Specialist:In-Network: 20% coinsurance per visit (authorization required) (referral not required)
    Specialist:Out-of-Network: 30% coinsurance per visit (authorization required) (referral not required)

    Emergency care/Urgent care

    Emergency: $90 copay per visit (always covered)
    Urgent care: $40 copay per visit (always covered)

    Foot care (podiatry services)

    Foot exams and treatment:In-Network: $0 copay (authorization required) (referral not required)
    Foot exams and treatment:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
    Routine foot care:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Routine foot care:Out-of-Network: 30% coinsurance (limits may apply) (authorization required) (referral not required)

    Ground ambulance

    In-Network: 20% coinsurance
    Out-of-Network: 20% coinsurance

    Health plan deductible

    $233 annual deductible

    Health plan deductibles (other)

    In-Network: No

    Hearing

    Fitting/evaluation: Not covered (no limits)
    Hearing aids:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Hearing aids:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Hearing exam:In-Network: $0 copay (authorization required) (referral not required)
    Hearing exam:Out-of-Network: 30% coinsurance (authorization required) (referral not required)

    Hospital coverage (inpatient)

    In-Network: $1,556 per stay
    $0 per day for days 91 and beyond (authorization required) (referral not required)
    Out-of-Network: 20% per stay (authorization required) (referral not required)

    Hospital coverage (outpatient)

    In-Network: 0-20% coinsurance per visit (authorization required) (referral not required)
    Out-of-Network: 30% coinsurance per visit (authorization required) (referral not required)

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

    $12,450 In and Out-of-network
    $8,300 In-network

    Medical equipment/supplies

    Diabetes supplies:In-Network: $0 copay per item (authorization required)
    Diabetes supplies:Out-of-Network: 30% coinsurance per item (authorization required)
    Durable medical equipment (e.g., wheelchairs, oxygen):In-Network: 20% coinsurance per item (authorization required)
    Durable medical equipment (e.g., wheelchairs, oxygen):Out-of-Network: 30% coinsurance per item (authorization required)
    Prosthetics (e.g., braces, artificial limbs):In-Network: 20% coinsurance per item (authorization required)
    Prosthetics (e.g., braces, artificial limbs):Out-of-Network: 30% coinsurance per item (authorization required)

    Medicare Part B drugs

    Chemotherapy:In-Network: 20% coinsurance (authorization required)
    Chemotherapy:Out-of-Network: 0-20% coinsurance (authorization required)
    Other Part B drugs:In-Network: 0-20% coinsurance (authorization required)
    Other Part B drugs:Out-of-Network: 0-20% coinsurance (authorization required)

    Mental health services

    Inpatient hospital – psychiatric:In-Network: $1,556 per stay (authorization required) (referral not required)
    Inpatient hospital – psychiatric:Out-of-Network: 20% per stay (authorization required) (referral not required)
    Outpatient group therapy visit:In-Network: $0 copay (authorization required) (referral not required)
    Outpatient group therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
    Outpatient group therapy visit with a psychiatrist:In-Network: $0 copay (authorization required) (referral not required)
    Outpatient group therapy visit with a psychiatrist:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
    Outpatient individual therapy visit:In-Network: $0 copay (authorization required) (referral not required)
    Outpatient individual therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
    Outpatient individual therapy visit with a psychiatrist:In-Network: $0 copay (authorization required) (referral not required)
    Outpatient individual therapy visit with a psychiatrist:Out-of-Network: 30% coinsurance (authorization required) (referral not required)

    Optional supplemental benefits

    No

    Preventive care

    In-Network: $0 copay (authorization not required) (referral not required)
    Out-of-Network: 0-30% coinsurance (authorization not required) (referral not required)

    Rehabilitation services

    Occupational therapy visit:In-Network: 20% coinsurance (authorization required) (referral not required)
    Occupational therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)
    Physical therapy and speech and language therapy visit:In-Network: 20% coinsurance (authorization required) (referral not required)
    Physical therapy and speech and language therapy visit:Out-of-Network: 30% coinsurance (authorization required) (referral not required)

    Skilled Nursing Facility

    In-Network: In 2023 the amounts for each benefit period are:
    $0 copay for days 1 through 20
    $200 copay per day for days 21 through 100 (authorization required) (referral not required)
    Out-of-Network: 20% per stay (authorization required) (referral not required)

    Transportation

    In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Out-of-Network: 75% coinsurance (limits may apply) (authorization not required) (referral not required)

    Vision

    Contact lenses:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Contact lenses:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Eyeglass frames: Not covered (no limits)
    Eyeglass lenses: Not covered (no limits)
    Eyeglasses (frames and lenses):In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Eyeglasses (frames and lenses):Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
    Other: Not covered (no limits)
    Routine eye exam:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
    Routine eye exam:Out-of-Network: 30% coinsurance (limits may apply) (authorization required) (referral not required)
    Upgrades: Not covered

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

    Covered (authorization not required) (referral not required)

    Ready to sign up for UnitedHealthcare Chronic Complete Assure (PPO C-SNP) ?

    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

    Table of Contents

    Need more information on UnitedHealthcare Chronic Complete Assure (PPO C-SNP)? See 2025 UnitedHealthcare Chronic Complete Assure (PPO C-SNP) at MedicareAdvantageRX.com.

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