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
(HMO)
2021 Plan Materials
Arizona
- Your Plan Explained (PDF)(881.0 KB)
- Summary of Benefits (PDF)(91.1 KB)
California
- Your Plan Explained (PDF)(794.4 KB)
- Summary of Benefits (PDF)(90.4 KB)
Nevada
- Your Plan Explained (PDF)(880.9 KB)
- Summary of Benefits (PDF)(90.0 KB)
Preventive services
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
- Screening for Sexually Transmitted Infections (STIs) and high intensity behavioral counseling to prevent STIs
- Intensive behavioral therapy to reduce cardiovascular disease risk
- Screening and counseling for obesity
For information about these preventive services, please call the Customer Service number on the back of your plan ID card.
Want to know what's changed in your plan?
Review the previous year's plan materials »
UnitedHealthcare® Senior Supplement +
UnitedHealthcare® MedicareRx for Groups (PDP)
2021 plan materials
Medical coverage
(UnitedHealthcare Senior Supplement)
- Plan Summary (PDF)(979.6 KB)
Prescription drug coverage
(UnitedHealthcare MedicareRx for Groups (PDP))
- Your Plan Explained (PDF)(749.1 KB)
- Summary of Benefits (PDF)(71.1 KB)
Preventive services
The following preventive services are covered under your plan for a $0 copay when you visit your physician:
- Screening and counseling to reduce alcohol misuse
- Screening for depression in adults
- Screening for Sexually Transmitted Infections (STIs) and high intensity behavioral counseling to prevent STIs
- Intensive behavioral therapy to reduce cardiovascular disease risk
- Screening and counseling for obesity
For information about these preventive services, please call the Customer Service number on the back of your plan ID card.
Want to know what's changed in your plan?
Review the previous year's plan materials »
| Benefits and costs | UnitedHealthcare® Group Medicare Advantage (HMO) |
UnitedHealthcare® Senior Supplement + UnitedHealthcare® MedicareRx for Groups |
|---|---|---|
| Annual medical deductible | None | None |
| Annual out-of-pocket maximum | $6,700 | None |
| Office and clinic visits | $20 copay primary care $20 copay specialist visit |
$0 copay |
| Hospital services (inpatient) | $0 copay | Days 1-60: Plan pays 100% of Medicare Part A deductible Days 61-90: Plan pays 100% copayment per day Days 91-150 (while using 60 lifetime reserve days): Plan pays 100% copayment per day Additional Days (after 60 lifetime reserve days are used): Plan pays 100% coinsurance Beyond 365 lifetime additional days: Plan does not cover and member pays the balance |
| Hospital services (outpatient) | $0 copay surgery and observation $0 copay all other procedures |
Medicare Part B Deductible: Plan pays 100% Medicare Part B Excess Charges: Plan pays 100% |
| Prescription drug coverage | Tier 1: Initial coverage limit: $4,130
|
Tier 1:
Prescription drug coverage is provided through a separate plan – UnitedHealthcare MedicareRx for Groups (PDP) |
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IMPORTANT DATES
2021 Open Enrollment Period
Began: 11/01/2020
Ended: 11/20/2020
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