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Coverage and benefits
Get a quick overview of your plan benefits, costs and find more detailed information about additional benefits and programs.
Important Information about your Part D Vaccine and Insulin Coverage
What You Pay for Vaccines – Our plan covers most adult Part D vaccines at no cost to you.
What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan. Refer to your plan materials.
UnitedHealthcare® Group Medicare Advantage (PPO)
2024 materials
Plan materials
Preventive services
The following preventive services are covered under your plan for a $0 copay when you visit your primary care provider:
- Annual Wellness Exam
- Annual Routine Physical
- Screenings for certain Cancers (Prostate, colorectal, breast cancer)
- Screening for diabetes
- Smoking and Tobacco Use Cessation
For more information about these preventive services, please call the Customer Service number on your member ID card.
Benefits and costs
| Benefits and costs | UnitedHealthcare® Group Medicare Advantage (PPO) |
|---|---|
| Annual medical deductible | $500 combined with out-of-network |
| Annual out-of-pocket maximum | $2,000 combined with out-of-network |
| Physician services | 20% coinsurance both in- and out-of-network |
| Hospital services (inpatient) | $200 days 1-5 both in- and out-of-network $0 days 6-999 both in- and out-of-network |
| Hospital services (outpatient) | 20% coinsurance both in- and out-of-network |
| Prescription drug coverage |
Retail Tier 1: $12 copay Mail Order Tier 1: $30 copay (90-day supply)Tier 2: $100 copay (90-day supply) Tier 3: $200 copay (90-day supply) Tier 4: $100 copay (30-day supply)
Catastrophic coverage stage: During this payment stage, the plan pays the full cost for your covered drugs. You pay nothing. |
| Rx Deductible | $150 |
Disclaimer
Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the costsharing that applies to out-of-network services.