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Coverage and benefits
Get a quick overview of your plan benefits and costs and find more detailed information about additional benefits and programs.
2024 Plan benefits
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
| Benefit | Pfizer Medicare Advantage Plan (PPO) |
|---|---|
| Annual medical deductible | $0 |
| Virtual visits | Medical and Behavioral Health visits are covered at 100% ($0 copay). |
| Annual out-of-pocket maximum | $1,500 – combined for in- and out-of-network |
| Office and clinic visits | $10 copay – primary care $20 copay – specialist |
| Hospital services (inpatient) | $250 cost share per admit |
| Hospital services (outpatient) | $150 copay – outpatient hospital services $150 copay – outpatient surgery |
| Urgent care | $35 copay – waived if admitted to the hospital within 24 hours for the same condition |
| Emergency department services | $120 copay – waived if admitted to the hospital within 24 hours for the same condition |
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.