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 Retiree Advantage Plan (PPO)
2021 Plan Materials
- Your Plan Explained (PDF)(895.9 KB)
- Summary of Benefits (PDF)(97.2 KB)
- Member Provider Guide to Care (PDF)(63.9 KB)
Over 12 million people have chosen UnitedHealthcare for their Medicare plans.
UnitedHealthcare has proudly served Medicare beneficiaries for over 40 years. *
You must be enrolled in a UnitedHealthcare Plan with the FEHBRA.
Rates can be found on your FEHBRA brochure for the plan you have enrolled in through your Federal program.
*2020 UnitedHealthcare Internal Data
The following preventive services are covered under your plan for a $0 copay when you visit your primary care provider:
- Screening and counseling to help reduce alcohol misuse
- Screening for depression in adults
- Screening for Sexually Transmitted Infections (STIs) and high intensity behavioral counseling to help prevent STIs
- Intensive behavioral therapy to help 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.
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 Retiree Advantage Plan (PPO)|
|Annual medical deductible||None|
|Annual out-of-pocket maximum||None|
|Office and clinic visits||$0 copay|
|Hospital services (inpatient)||$0 copay|
|Hospital services (outpatient)||$0 copay|
|Prescription drug coverage||Retail
Tier 1: $7 copay
Tier 2: $35 copay
Tier 3: $65 copay
Tier 4: $100 copay
Tier 1: $14 copay
Tier 2: $70 copay
Tier 3: $130 copay
Tier 4: $200 copay
The UnitedHealthcare Retiree Advantage Plan PPO offers additional coverage for the coverage gap (donut hole). You will continue to pay your normal copays once you enter the donut hole. Once your True Out of Pocket (TROOP) reaches $6,350 you enter the Catastrophic Coverage level and will pay $3.60 for a 30-day supply of generic medications or $8.95 for a 30-day supply of all other medications.
2021 Open Enrollment Period
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