Insurance & Coverage
Sarah Johnson · MRN P-2024-042
Medicare Advantage
UnitedHealthcare Medicare Plan A
Member ID
H5253-001-98762
Group #
MA-GROUP-4421
Effective Date
Jan 1, 2025
Term Date
Dec 31, 2026
Member: Sarah B. Johnson · DOB: 03/15/1958 · Subscriber
✓ Verified — Apr 1, 2026
Auto-verified nightly
Plan Details
Payer NameUnitedHealthcare
Plan NameMedicare Advantage Plan A
Plan TypeHMO-POS
Payer ID (EDI)87726
RxBIN610272
RxPCNADJ
PCPDr. Michael Walsh, MD
Authorization RequiredYes — Most specialties
Benefits Summary
| Benefit | In-Network | Out-of-Network |
|---|---|---|
| Annual Deductible | $0 | $3,400 |
| Deductible Used YTD | — | $0 |
| Out-of-Pocket Max | $7,550 | N/A |
| PCP Copay | $10 | Not covered |
| Specialist Copay | $40 | Not covered |
| Urgent Care | $65 | $65 |
| Emergency Room | $120 | $120 |
| Inpatient Hospital | $295/day (Days 1–7) | N/A |
| Generic Rx | $0–$5 | N/A |
| Brand Rx (Preferred) | $37 | N/A |
| CCM Services | Covered ($0 copay) | N/A |
SecondaryMedicaid — MassHealth Standard