Physicians United Plan HMO is a Coordinated Care Plan that has a URAC accreditation and a Medicare Advantage contract. Those who are eligible for this plan has both Medicare Part A and Medicare Part B and lives in selected counties in the state of Florida. Members must use in-network doctors, specialists and hospitals unless in extraordinary circumstances. The beneficiary is still responsible for his/her Part B deductible if a PUP Medicare Advantage plan is received. There are three Medicare Advantage groups which fall under the Physicians United Plan. They are the Medicare Advantage with Prescription Drug Plans, Medicare Advantage MA-only, and Medicare Advantage- Special Needs Plan. Look below to find your area:
Medicare Advantage with Prescription Drug Plans:
Brevard, Manatee, Marion and Pasco Counties
PUP Easy
There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $175 per day from days 1-8, and there is a $0 co-pay for days 9-90. There is a $175 per day for days 1-8 and a $0 co-pay per day for days 9-90 in an inpatient mental care facility and members are given 190 days per lifetime. Members pay $75 per day from days 1-39 in a skilled nursing facility and $0 per day from days 40-100. There is a $0 copay for each primary care doctor visit, $30 copay for each urgent care visit, and $25 copay for each specialist visit.
PUP Rewards
There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. PUP will also reduce the beneficiary's monthly Medicare Part B premium up to $50. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $290 per day from days 1-6, and there is a $0 co-pay for days 7-90. There is a $300 per day for days 1-6 and a $0 co-pay per day for days 7-90 in an inpatient mental care facility and members are given 190 days per lifetime. Members pay $100 per day from days 1-29 in a skilled nursing facility and $0 per day from days 30-100. There is a $10 copay for each primary care doctor visit, $30 copay for each urgent care visit, and $35 copay for each specialist visit.
Hillsborough, Lake, Orange, Osceola, Pinellas, Seminole and Sumter Counties
PUP Easy
There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $80 per day from days 1-10, and there is a $0 co-pay for days 11-90. There is a $80 per day for days 1-10 and a $0 co-pay per day for days 11-90 in an inpatient mental care facility and members are given 190 days per lifetime. Members pay $75 per day from days 1-39 in a skilled nursing facility and $0 per day from days 40-100. There is a $0 copay for each primary care doctor visit, $25 copay for each urgent care visit, and $20 copay for each specialist visit.
PUP Rewards
There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. PUP will also reduce the beneficiary's monthly Medicare Part B premium up to $67. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $225 per day from days 1-7, and there is a $0 co-pay for days 8-90. There is a $225 per day for days 1-7 and a $0 co-pay per day for days 8-90 in an inpatient mental care facility and members are given 190 days per lifetime. Members pay $75 per day from days 1-39 in a skilled nursing facility and $0 per day from days 40-100. There is a $5 copay for each primary care doctor visit, $30 copay for each urgent care visit, and $30 copay for each specialist visit.
Miami-Dade County
PUP Easy
There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $0 copay and the plan covers a 90-day benefit period. There is $0 copay and members are given 190 days per lifetime for mental health facilities. Members pay $0 per day from days 1-10 in a skilled nursing facility and $25 per day from days 11-100. There is a $0 copay for each primary care doctor visit, urgent care visit, and specialist visit.
PUP Rewards
There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. PUP will also reduce the beneficiary's monthly Medicare Part B premium up to $96.40. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $75 per day from days 1-7, and there is a $0 co-pay for days 8-90. There is a $75 per day for days 1-7 and a $0 co-pay per day for days 8-90 in an inpatient mental care facility and members are given 190 days per lifetime. Members pay $35 per day from days 1-100 in a skilled nursing facility. There is a $0 copay for each primary care doctor visit, $0 copay for each urgent care visit, and $5 copay for each specialist visit.
Broward and Palm Beach Counties
PUP Easy
There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $50 per day from days 1-6, and there is a $0 co-pay for days 7-90. There is a $50 per day for days 1-6 and a $0 co-pay per day for days 7-90 in an inpatient mental care facility and members are given 190 days per lifetime. Members pay $0 per day from days 1-10 in a skilled nursing facility and $25 per day from days 11-100. There is a $0 copay for each primary care doctor visit, $5 copay for each urgent care visit, and $5 copay for each specialist visit.
PUP Rewards
There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. PUP will also reduce the beneficiary's monthly Medicare Part B premium up to $96.40. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $125 per day from days 1-7, and there is a $0 co-pay for days 8-90. There is a $125 per day for days 1-7 and a $0 co-pay per day for days 8-90 in an inpatient mental care facility and members are given 190 days per lifetime. Members pay $35 per day from days 1-100. There is a $0 copay for each primary care doctor visit, $0 copay for each urgent care visit, and $20 copay for each specialist visit.
Polk County
PUP Easy
There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $175 per day from days 1-5, and there is a $0 co-pay for days 6-90. There is a $175 per day for days 1-5 and a $0 co-pay per day for days 6-90 in an inpatient mental care facility and members are given 190 days per lifetime. Members pay $75 per day from days 1-39 in a skilled nursing facility and $0 per day from days 40-100. There is a $0 copay for each primary care doctor visit, $30 copay for each urgent care visit, and $25 copay for each specialist visit.
PUP Rewards
There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. PUP will also reduce the beneficiary's monthly Medicare Part B premium up to $67. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $290 per day from days 1-6, and there is a $0 co-pay for days 7-90. There is a $300 per day for days 1-6 and a $0 copay per day for days 7-90 in an inpatient mental care facility and members are given 190 days per lifetime. Members pay $100 per day from days 1-29 and $0 per day from days 30-100. There is a $10 copay for each primary care doctor visit, $30 copay for each urgent care visit, and $35 copay for each specialist visit.
Medicare Advantage (MA-only)
Brevard, Broward, Hillsborough, Lake, Manatee, Marion, Miami Dade, Osceola, Orange, Palm Beach, Polk, Pasco, Pinellas, Sumter, and Seminole
PUP Perks
There is a $0 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. PUP will also reduce the beneficiary's monthly Medicare Part B premium up to $55. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $250 per day from days 1-5, and there is a $0 co-pay for days 6-90. There is a $250 per day for days 1-5 and a $0 copay per day for days 6-90 in an inpatient mental care facility and members are given 190 days per lifetime. Members pay $50 per day from days 1-88 and $0 per day from days 89-100. There is a $10 copay for each primary care doctor visit, $35 copay for each urgent care visit, and $35 copay for each specialist visit.
Medicare Advantage Special Needs Plan
Hillsborough, Lake, Orange, Osceola, Pasco, Pinellas, Polk and Seminole Counties
PUP Extra
There is a $20 monthly plan premium in addition to the beneficiary's monthly Medicare Part B premium. Members must go to in-network doctors, specialists and hospitals and referral is required for in-network specialists. For hospital stays, members pay $0 copay and the plan covers a 90-day benefit period. There is $0 copay and members are given 190 days per lifetime for mental health care facilities. Members pay $0 per day and there is a 100-day benefit period for skilled nursing facilities. There is a $0 copay for each primary care doctor visit, urgent care visit, and specialist visit. To receive the PUP Extra (HMO) plan, which is a Special Needs Plan, the beneficiary must have assistance from the state.
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