Coverage and benefits

Get a quick overview of your plan benefits and 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

Plans

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

Plan options and costs
Benefits and costs

UnitedHealthcare Group Medicare Advantage (PPO)

UnitedHealthcare Group Medicare Advantage (PPO)
Annual medical deductible

$500
Annual medical deductible

$500
Annual out-of-pocket maximum

$1000
Annual out-of-pocket maximum

$1000
Office and clinic visits

$0 copay
Office and clinic visits

$0 copay
Hospital services (inpatient)

$250 copay per admit
Hospital services (inpatient)

$250 copay per admit
Hospital services (outpatient)

$0 copay
Hospital services (outpatient)

$0 copay
Hearing aid allowance

$500 every three years
Hearing aid allowance

$500 every three years
Routine podiatry visits

$0 up to 6 per year
Routine podiatry visits

$0 up to 6 per year
Ambulance

$0 copay
Ambulance

$0 copay
Emergency room visits

$100 copay
Emergency room visits

$100 copay
Prescription drug co-pays by tier

Tier 1: $10 copay 

Tier 2: $40 copay

Tier 3: 50% coinsurance up to $95

Tier 4: 50% coinsurance up to $95

Estimate Drug Cost
Prescription drug co-pays by tier

Tier 1: $10 copay 

Tier 2: $40 copay

Tier 3: 50% coinsurance up to $95

Tier 4: 50% coinsurance up to $95

Estimate Drug Cost

Disclaimer

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare members, except in emergency situations. Please call (1-866-827-9022) our customer service number or see your Evidence of Coverage for more information, including the costsharing that applies to out-of-network services.