Review plan benefits & costs
Get a quick overview of your plan benefits and costs, and find more detailed information about additional coverage and benefit services.
UnitedHealthcare® Group Medicare Advantage
The following preventive services are covered under your plan for a $0 copay when you visit your primary care provider:
- Screening and counseling to reduce alcohol misuse
- Screening for depression in adults
- Intensive behavioral therapy to reduce cardiovascular disease risk
- Screening and counseling for obesity
- Screening for Sexually Transmitted Infections (STIs) and high intensity behavioral counseling to prevent STIs
For information about these preventive services, please call the Customer Service number on the back of your plan ID card.
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.
|Benefits and costs||UnitedHealthcare® Group Medicare Advantage|
|Annual medical deductible||$0|
|Annual out-of-pocket maximum||$6,700|
|Office and clinic visits||$20 copay for primary care
$30 copay for specialist visit
$0 copay for Virtual Doctor Visit
|Behavioral health||$20 copay in office
$20 copay for Virtual Behavioral Health Visit
|Urgent care||$30 copay|
|Hospital services (inpatient)||$200 copay day 1
$50 copay days 2-5
$0 copay days 6-Unlimited
|Hospital services (outpatient)||$0 copay|
|Diabetic supplies and monitors||
In-network: $0 copay
For diabetes monitoring supplies, the plan covers the following brands of blood glucose monitors and test strips: OneTouch® Ultra® 2, OneTouch® Verio™, OneTouch® UltraMini™, ACCU-CHEK® Aviva, ACCU-CHEK® Compact, ACCU-CHEK® SmartView. Other brands are not covered by our plan.
If you use a brand of supplies that is not covered by our plan, you should speak with your doctor to get a new prescription for a covered brand.
|Prescription drug coverage||
Tier 1 Generic – up to 30-day supply: $10 copay
Tier 2* Preferred Brand – up to 30-day supply: 20% coinsurance
Tier 3* Non-Preferred Brand – up to 30-day supply: 20% coinsurance
Tier 4* Specialty Tier – up to 30-day supply: 20% coinsurance
*For Tiers 2, 3 & 4 there is a $100 deductible before your coinsurance begins
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