U gudub tusmada ugu weyn Tusmada Ugu Weyn

Maine qorshayasha caafimaadka

Ma waxaad raadinaysaa caymis caafimaad oo qiimo jaban ama aan qiimo lahayn? We offer dual health plans for people with Medicaid and Medicare. 

5  Natiijooyinka loogu talogalay Maine

Shaandhee Qorsheyaasha

U Shaqaadhee Nooca Qorshaha

Tirtir shaandheeyeyaasha oo dhan

2024 UHC Dual Complete ME-S001 (PPO D-SNP)

H0271-006-000

Qiimeynta CMS lama dabaqi karo

Qiimaha bishii: $0.00*

* Kharashkaagu waxa laga yaabaa inuu u hooseeyo ilaa $0, iyadoo ay ku xirantahay heerkaaga u-qalmitaanka Medicaid. 

Qorshahan caafimaadka ee laba-geesodka ah waxaa loogu talagalay dadka u qalma Medicaid iyo Medicare Qaybaha A & B (Asal ahaan Medicare).

Kani waa Qorshaha Ururka Bixiyaha ee La Doorbiday (PPO). Waxaad marin u heli kartaa shabakada deegaanka ee dhakhaatiirta iyo isbitaallada. Waxaa dheer, waxaad arki kartaa bixiye kasta oo ka baxsan shabakada qaranka oo dhan kaas oo ka qaybqaata Medicare oo aqbala qorshaha. Waxaa laga yaabaa inaad bixiso lacag-bixin sare ama caymis marka aad aragto bixiye shabakad ka baxsan.

Androscoggin, Cumberland, Franklin, Kennebec, Knox, Lincoln, Oxford, Sagadahoc, Waldo, and York.

Macaashyada & Sifooyinka

  • Cuntada, Dawooyinka Laga Gato Farmashi Iyadoo Dhaqtari Uusan Soo Qorin iyo Tamarta

    $80 credit every month to pay for healthy food, OTC products and utility bills

  • Faa'iidooyinka ilkaha

    $2500 allowance for covered preventive and comprehensive dental services

  • Caymiska Daawooyinka Dhakhtarka uu soo qoro:

    $0 copay for generic and brand-name prescriptions including Optum® Home Delivery

Eeg Faahfaahinta Qorshaha Hubi u-qalmitaanka (Furaysa daaqada modelka)

Ma qabtaa su'aalo?    8 sn. – 8 gn. waqtiga maxaliga ah ee deegaanka, 7 maalmood toddobaadkii 1-844-812-5967    TTY 711

2024 UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)

H0271-020-000

Qiimeynta CMS lama dabaqi karo

Qiimaha bishii: $0.00*

* Kharashkaagu waxa laga yaabaa inuu u hooseeyo ilaa $0, iyadoo ay ku xirantahay heerkaaga u-qalmitaanka Medicaid. 

Qorshahan caafimaadka ee laba-geesodka ah waxaa loogu talagalay dadka u qalma Medicaid iyo Medicare Qaybaha A & B (Asal ahaan Medicare).

Kani waa Qorshaha Ururka Bixiyaha ee La Doorbiday (PPO). Waxaad marin u heli kartaa shabakada deegaanka ee dhakhaatiirta iyo isbitaallada. Waxaa dheer, waxaad arki kartaa bixiye kasta oo ka baxsan shabakada qaranka oo dhan kaas oo ka qaybqaata Medicare oo aqbala qorshaha. Waxaa laga yaabaa inaad bixiso lacag-bixin sare ama caymis marka aad aragto bixiye shabakad ka baxsan.

Aroostook, Hancock, Penobscot, Piscataquis, Somerset, and Washington.

Macaashyada & Sifooyinka

  • Cuntada, Dawooyinka Laga Gato Farmashi Iyadoo Dhaqtari Uusan Soo Qorin iyo Tamarta

    $86 credit every month to pay for healthy food, OTC products and utility bills

  • Faa'iidooyinka ilkaha

    $2000 allowance for covered preventive and comprehensive dental services

  • Caymiska Daawooyinka Dhakhtarka uu soo qoro:

    $0 copay for generic and brand-name prescriptions including Optum® Home Delivery

Eeg Faahfaahinta Qorshaha Hubi u-qalmitaanka (Furaysa daaqada modelka)

Ma qabtaa su'aalo?    8 sn. – 8 gn. waqtiga maxaliga ah ee deegaanka, 7 maalmood toddobaadkii 1-844-812-5967    TTY 711

Ma u baahan tahay in lagaa caawiyo helida qorshaha?

Ka jawaab dhawr su'aalood oo degdeg ah si aad u aragto nooca qorshaha ee adiga si wanaagsan kugu habboon.

Qorshaha u-qalmitaanka qalabka

2024 UHC Dual Complete ME-S003 (PPO D-SNP)

H0271-065-000

Qiimeynta CMS lama dabaqi karo

Qiimaha bishii: $0.00*

* Kharashkaagu waxa laga yaabaa inuu u hooseeyo ilaa $0, iyadoo ay ku xirantahay heerkaaga u-qalmitaanka Medicaid. 

Qorshahan caafimaadka ee laba-geesodka ah waxaa loogu talagalay dadka u qalma Medicaid iyo Medicare Qaybaha A & B (Asal ahaan Medicare).

Kani waa Qorshaha Ururka Bixiyaha ee La Doorbiday (PPO). Waxaad marin u heli kartaa shabakada deegaanka ee dhakhaatiirta iyo isbitaallada. Waxaa dheer, waxaad arki kartaa bixiye kasta oo ka baxsan shabakada qaranka oo dhan kaas oo ka qaybqaata Medicare oo aqbala qorshaha. Waxaa laga yaabaa inaad bixiso lacag-bixin sare ama caymis marka aad aragto bixiye shabakad ka baxsan.

Androscoggin, Cumberland, Franklin, Kennebec, Knox, Lincoln, Oxford, Sagadahoc, Waldo, and York.

Macaashyada & Sifooyinka

  • Cuntada, Dawooyinka Laga Gato Farmashi Iyadoo Dhaqtari Uusan Soo Qorin iyo Tamarta

    $161 credit every month to pay for healthy food, OTC products and utility bills

  • Faa'iidooyinka ilkaha

    $0 copay for network dental such as exams, x-rays, and routine cleanings

  • Caymiska Daawooyinka Dhakhtarka uu soo qoro:

    $0 copay for generic and brand-name prescriptions including Optum® Home Delivery

Eeg Faahfaahinta Qorshaha Hubi u-qalmitaanka (Furaysa daaqada modelka)

Ma qabtaa su'aalo?    8 sn. – 8 gn. waqtiga maxaliga ah ee deegaanka, 7 maalmood toddobaadkii 1-844-812-5967    TTY 711

2023 UnitedHealthcare Dual Complete® (PPO D-SNP)

H0271-006-000

Qiimaynta CMS 45 ee xiddigood.

Qiimaha bishii: $0.00*

* Kharashkaagu waxa laga yaabaa inuu u hooseeyo ilaa $0, iyadoo ay ku xirantahay heerkaaga u-qalmitaanka Medicaid. 

Qorshahan caafimaadka ee laba-geesodka ah waxaa loogu talagalay dadka u qalma Medicaid iyo Medicare Qaybaha A & B (Asal ahaan Medicare).

Kani waa Qorshaha Ururka Bixiyaha ee La Doorbiday (PPO). Waxaad marin u heli kartaa shabakada deegaanka ee dhakhaatiirta iyo isbitaallada. Waxaa dheer, waxaad arki kartaa bixiye kasta oo ka baxsan shabakada qaranka oo dhan kaas oo ka qaybqaata Medicare oo aqbala qorshaha. Waxaa laga yaabaa inaad bixiso lacag-bixin sare ama caymis marka aad aragto bixiye shabakad ka baxsan.

Androscoggin, Cumberland, Franklin, Kennebec, Knox, Lincoln, Oxford, Sagadahoc, Waldo, and York.

Macaashyada & Sifooyinka

  • Cuntada OTC, amarta

    $80 bishii si aad u iibsato cunto caafimaad leh iyo alaabta OTC ama aad ku bixiso biilasha tamarta

  • Faa'iidooyinka ilkaha

    Ilaa $3000 ee noocyada daboolan ee ka hortagga iyo ilkaha dhammaystiran

  • Caymiska Daawooyinka Dhakhtarka uu soo qoro:

    $0 lacag bixinta dawooyinka guud ee la caymiyay iyo magaca summada oo ay ku jiraan geynta guriga

Is diwaangeli Qorshaha (Waxay furtaa daaqada modal) Arag Faahfaahinta Qorshaha Hubi u-qalmitaanka (Furaysa daaqada modelka)

Ma qabtaa su'aalo?    8 sn. – 8 gn. waqtiga maxaliga ah ee deegaanka, 7 maalmood toddobaadkii 1-844-812-5967    TTY 711

2023 UnitedHealthcare NorthernLightHealth Dual Complete® (PPO D-SNP)

H0271-020-000

Qiimaynta CMS 45 ee xiddigood.

Qiimaha bishii: $0.00*

* Kharashkaagu waxa laga yaabaa inuu u hooseeyo ilaa $0, iyadoo ay ku xirantahay heerkaaga u-qalmitaanka Medicaid. 

Qorshahan caafimaadka ee laba-geesodka ah waxaa loogu talagalay dadka u qalma Medicaid iyo Medicare Qaybaha A & B (Asal ahaan Medicare).

Kani waa Qorshaha Ururka Bixiyaha ee La Doorbiday (PPO). Waxaad marin u heli kartaa shabakada deegaanka ee dhakhaatiirta iyo isbitaallada. Waxaa dheer, waxaad arki kartaa bixiye kasta oo ka baxsan shabakada qaranka oo dhan kaas oo ka qaybqaata Medicare oo aqbala qorshaha. Waxaa laga yaabaa inaad bixiso lacag-bixin sare ama caymis marka aad aragto bixiye shabakad ka baxsan.

Aroostook, Hancock, Penobscot, Piscataquis, Somerset, and Washington.

Macaashyada & Sifooyinka

  • Cuntada OTC, amarta

    $75 bishii si aad u iibsato cunto caafimaad leh iyo alaabta OTC ama aad ku bixiso biilasha tamarta

  • Faa'iidooyinka ilkaha

    Ilaa $2000 ee noocyada daboolan ee ka hortagga iyo ilkaha dhammaystiran

  • Caymiska Daawooyinka Dhakhtarka uu soo qoro:

    $0 lacag bixinta dawooyinka guud ee la caymiyay iyo magaca summada oo ay ku jiraan geynta guriga

Is diwaangeli Qorshaha (Waxay furtaa daaqada modal) Arag Faahfaahinta Qorshaha Hubi u-qalmitaanka (Furaysa daaqada modelka)

Ma qabtaa su'aalo?    8 sn. – 8 gn. waqtiga maxaliga ah ee deegaanka, 7 maalmood toddobaadkii 1-844-812-5967    TTY 711

Macluumaadka Afeefta
(ku dhex wad bogoskan si aad u aragto)

Ma waxaad raadinaysaa mareegta dawladda dhexe ee Medicaid? Halkan ka eeg Medicaid.gov.

UnitedHealthcare Dual Complete Plans

Qorsheyaasha waxaa la doolaa iyadoo loo sii marayo Shirkadda Caymiska UnitedHealthcare ama mid ka mid ah shirkadaheeda xiriirka la leh, Hay'adda Medicare Advantage ee haysata qandaraaska Medicare iyo qandaraaska kula jirto Barnaamijka Medicaid ee Gobolka. Iska diiwaangelinta qorshaha waxay ku xiran tahay heshiiska cusboonaysiinta qorshaha ee Medicare. Qorshahan waxaa heli kara qof kasta oo haysta Medical Assistance ee laga helo Gobolka iyo Medicare. Dheefaha, qaybaha iyo/ama aaladuhu waxay ku kala duwan yihiin qorshe/aagga. Limitations, exclusions and/or network restrictions may apply. Macaashyada, khidmadaha iyo/ama kharashka la wada bixiyo/qaybsiga caymiska ayaa laga yaabaa inay isbeddelaan markay tahay 1-da Janaayo ee sannad kasta.

Premium Disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Afeefta Khadka-furan ee Kalkaalisada

Adeegani waa inaan loo isticmaalin baahiyada gurmadka ama daryeelka ee degdegga ah. Marka ay jirto xaalad degdega ah, wac 911 ama tag qolka gurmadka ee kuugu dhow. Macluumaadka lagu bixiyay adeegan waxaa laga leeyahay ujeedooyin waxbixin oo keliya. Kalkaaliyeyaashu ma sheegi karaan dhibaatooyinka ama kuma talin karaan daaweyn mana u noqon karaan beddel daryeelka daryeel bixiyahaaga. Macluumaadkaaga caafimaad waxaa loo keydiyaa si qarsoodi ah oo waafaqsan sharciga. Adeeggu maaha barnaamij caymis waxaana laga yaabaa in la joojiyo wakhti kasta. Khadka Taleefanka ee Kalkaalisada looma isticmaalo xaaladaha degdegga ah, ujeeddooyin macluumaad oo keliya ayaa loo isticmaalaa.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) waa qorshe caafimaad oo qandaraas la leh Medicare iyo Medicaid Ohio labaduba si ay u siiyaan macaashyada labada barnaamij dadka ka diiwaangashan. 

UnitedHealthcare Connected® (Medicare-Medicaid Plan)

UnitedHealthcare Connected® (Medicare-Medicaid Plan) waa qorshe caafimaad oo qandraas la leh Medicare iyo Texas Medicaid Ohio labaduba si ay u siiyaan macaashyada labada barnaamij dadka ka diiwaangashan.

UnitedHealthcare Connected® oo loogu tala galay One Care (Qorshaha Medicaid - Medicare)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan) waa qorshe caafimaad oo qandraas la leh Medicare iyo MassHealth (Medicaid) labadaba si ay u siiyaan manaafacaadka labada barnaamij dadka ka diiwaangashan. 

Afeefta dheefaha guud UnitedHealthcare Connected®

Kani ma ahan liis dhammeystiran. Macluumaadka macaashka waa qoraal kooban, ma ahan sharraxaadda dhammeystiran ee macaashyada. Si aad u hesho macluumaad dheeraad ah la xiriira qorshaha ama akhri Buug-gacmeedka Xubinta. Xaddidaado, wada-bixinno, iyo xannibaado ayaa lagu dabaqi karaa. Wixii macluumad dheeraad ah, wac Adeegyada Xubnaha ee ku xiran UnitedHealthcare ama aqri Buugyaraha Xubnaha ee UnitedHealthcare Connected®. 

UnitedHealthcare Senior Care Options (HMO SNP) Plan

Dookhyada Daryeelka Waayeeladda ee UnitedHealthcare (SCO) waa qorshaha Daryeelka Isku Dubaridan ee la leh qandaraas Medicare iyo qandaraas kula jira barnaamijka Common Wealth Massachusetts of Medicaid. Iska diiwaangelinta qorshaha waxay ku xiran tahay heshiiska cusboonaysiinta qorshaha ee Medicare. Qorshahan waa barnaamij isxilqaan ah uu heli karo qof kasta oo jira 65 iyo ka weyn oo u-qalma MassHealth Standard iyo Original Medicare oo aan lahayn caymis caafimaad ee kale ee dhamaystiran, marka laga reebo Medicare. Haddii aad leedahay MassHealth Standard, balse aadan u-qalmin Original Medicare, waxaa laga yaabaa inaad weli u-qalanto inaad iska diiwaangeliso qorshaheena MassHealth Senior Care Option oo aad hesho macaashyadaada MassHealth oo dhan adoo u maraya barnaamijkeena Dookhyada Daryeelka Waayeeladda ee UnitedHealthcare (SCO).

Afeefta qiimeynta xidigeed

Sannad kasta, Medicare waxay qiimaysaa qorsheyaasha iyadoo ku salaysa nidaamka qiimeynta 5-Xiddig. Nidaamka qiimeynta 5 Xiddigta waxa uu khuseeyaa qorshaha sanadka 2023.

Macluumaadka bixiyaha ee muhiimka ah

Go'aanka Adigaa Leh.

Waxaan ku siin doonaa macluumaad kaa caawin doona inaad gaarto go'aano wargal ah, sida aqoonsashada dhakhaatiirta iyo xirfadleyaasha daryeelka caafimaadka. Macluumaadkan, si kastaba ha ahaatee, ma ahan mid ayidaya dhakhtar gaar ah ama xirfadlaha daryeelka caafimaadka ee ku habboon baahidaada.

Bixiyeyaasha la heli karo iyadoo loo marayo codsigan ma ahan inay xaqiiqdii uga turjumayaan si buuxda shabakada UnitedHealthcare ee bixiyeyaasha qandaraaska lagula jiro. Waxaa laga yaabaa inay jiraan bixiyeyaal ama takhasusleyaal gaar ah oo aan lagu darin codsigan oo qayb ka ah shabakadeena. Haddii aadan helin bixiyaha aad raadinayso, waxaad si toos ah ula xiriiri kartaa bixiyaha si aad u xaqiijiso xaaladda kaqaybgalka ee shabakadda UnitedHealthcare, ama kala xiriir Mamber Services lambarka bilaashka ah ee ku qoran kaarkaaga aqoonsiga UnitedHealthcare. Waxaan sidoo kale kugula talineynaa, kahor inta aadan la kulmin dhakhtar kasta, oo ay ku jiraan takhasusleyaal kasta, inaad wacdo xafiiska dhakhtarka si aad u xaqiijiso xaaladda kaqaybgalka iyo helitaanka.

Qaar kamid ah shabakadda bixiyeyaasha ayaa laga yaabaa in lagu daray ama laga saaray shabakadeena kadib markii diiwaankan la cusbooneysiiyay. Ma dammaanad qaadi karno in bixiye kasta weli aqbalayo xubno cusub.

Bixiyeyaasha shabakadda ka baxsan/qandaraaska haysan kuma qasbana inay daaweeyaan xubnaha ku jira qorshaha UnitedHealthcare, marka laga reebo xaaladaha gurmadka ah. Fadlan soo wac lambarkeena adeegga macmiilka ama ka eeg Caddayntaada Caymis wixii macluumaad dheeraad ah, oo ay ku jiraan kharash wadaagga khuseeya adeegyada shabakadda ka baxsan.

Ogeysiiska Xeerka Naafada Mareykanka

Sida waafaqsan shuruudaha Xeerka Naafada ee Dawladda Dhexe Maraykanka 1990 iyo Qeybta 504 Xeerka Baxnaaninta 1973 ("ADA"), Shirkadda Caymiska UnitedHealthcare waxay bixisa adeegyada la daboolay oo buuxa oo loo siman yahay mana takooraan shakhsiyaadka u-qalma ee naafada ah iyadoo lagu salaynayo naafanimada markay bixinayaan adeegyadooda, barnaamijyadooda, ama waxqabadooda.

Gudbinta

Bixiyeyaasha shabakadda ayaa idin ka caawin doona adiga iyo xubnaha qoyskaaga ee caymiska leh inaad heshaan daryeelka aad u baahan tihiin. Helitaanka dhakhaatiirta takhasuska leh waxaa isku dubaridi kara dhakhtarkaaga daryeelka aasaasiga ah.

Codsiyada diiwaanka waraaqaha

Nuqullada warqadaha ee ku jira diiwaanka bixiyaha shabakadda waxay ku heli karaan xubnaha si bilaash ah iyagoo wacaya lambarka adeegga macmiilka ee ku yaala gadaasha kaarka aqoonsiga. Dadka aan xubinta ka ahayn waxay natiijooyinka ka soo dejisan karaan oo ka daabacan karaan diiwaanka onlaynka ah.

Macluumaadka khaldan

Si aad uga warbixiso xogta khaldan, u dir iimayl provider_directory_invalid_issues@uhc.com. Bogoskan iimaylka waxaa loogu talagalay xubnaha si ay uga warbixiyaan khaladaadka suurtagalka ah ee macluumaadka qofka (cinwaanka, telefoonka, iwm.) ee ku jira hagaha diiwaanka onlaynka ah ama waraaqaha. Ka warbixinta arrimaha iyadoo loo marayo bogoskan boostada waxay keeni doontaa in la gaaro xafiiska bixiyaha si loo xaqiijiyo dhammaan xogta dadka ee ku jira diiwaanka, taasoo qaadan karta qiyaastii 30 maalmood. Shakhsiyaadka sidoo kale waxay soo sheegi karaan khaladaadka suurtagalka ah iyagoo adeegsanaya telefoonka. Xubnaha UnitedHealthcare waa inay wacaan lambarka ku yaala gadaasha kaarkooda aqoonsiga, halka dadka aan xubin ka ahayn UnitedHealthcare ay soo wici karaan 1-888-638-6613 TTY 711, ama waxay isticmaali karaan adeegga gudbinta ee ay doorbidayaan.

Ku Dhawaaqida Musiibo ama Xaalad Degdeg ah

Haddii ay ku saamayso ku dhawaaqida musiibo ama xaalad degdega ah ee Madaxweynaha ama Guddoomiyaha Gobolka, ama oggeysiiska xaalad caafimaadka dadweynaha ee degdeg ah oo uu ku dhawaaqay Xoghayaha Caafimaadka iyo Adeegyada Aadanaha, waxa jira taageero dheeraad ah oo gaar ah oo adiga diyaar kuu ah.

  • Qaybta A, Qaybta B, iyo dheefaha qorshaha Qaybta C ee dheeraadka ah waa in lagu bixiyaa xarumo aan qandaraaska lahayn oo gaar ah (ogsoonow in dheefaha Qaybta A iyo Qaybta B ay tahay in laga helo xarumaha shahaadaysan ee Medicare);
  • Meeshii ay ku habboon tahay, shuruudaha loogu talagalay gudbinta albaab-ilaaliyaha si buuxda ayaa looga dhaafay;
  • Wadaagista kharashka shabakada ka baxsan ee qorshaha la ansixiyay ilaa qadarada wadaagista kharashka shabakada ayaa si ku meelgaar ah loo dhimay; iyo
  • Shuruudaha oggeysiiska ee 30-ka maalin ah ee ku aadan xubnaha waa la dhaafay, ilaa inta dhammaan isbeddellada dheefta (sida dhimista wadaagista kharashka iyo oggolaanshaha ka dhaafitaanka) ee xubinta.

Haddii CMS aysan bixin taariikhda dhammaadka ee loogu talagalay musiibada ama xaaladda degdegga ah, qorshooyinka ayaa dib u bilaabi doona maalmaha 30 shaqada ee caadiga ah ka dib ku dhawaaqista hore.

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