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 (HMO)

2024 materials

Arizona

California

Nevada

UnitedHealthcare® Senior Supplement + UnitedHealthcare® MedicareRx for Groups (PDP)

2024 materials

Medical coverage (UnitedHealthcare Senior Supplement

Prescription drug coverage (UnitedHealthcare MedicareRx for Groups (PDP))

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

Benefits and costs
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 visitt		 $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

Retail ( 30-day supply)

Tier 1: $10 copay
Tier 2: $30 copay
Tier 3: $30 copay
Tier 4: $30 copay

Mail Order ( 90-day supply)

Tier 1: $20 copay
Tier 2: $60 copay
Tier 3: $60 copay
Tier 4: $60 copay

 

Initial coverage limit: $4,660

Catastrophic coverage:
After your total out-of-pocket costs reach $7,400, you enter the Catastrophic Coverage stage. In this stage, you pay a small copay, of $4.15 for generic drugs and $10.35 for brand name drugs and you stay in this stage for the rest of the plan year.

 

Retail (30-day supply)

Tier 1: $10 copay
Tier 2: $35 copay
Tier 3: $50 copay
Tier 4: $50 copay

Mail order (90-day supply)

Tier 1: $20 copay
Tier 2: $70 copay
Tier 3: $100 copay
Tier 4: $100 copay

 

Initial coverage limit: $4,660

Catastrophic coverage:

After your total out-of-pocket costs reach $7,400, you enter the Catastrophic Coverage stage. In this stage, you pay a small copay, of $4.15 for generic drugs and $10.35 for brand name drugs and you stay in this stage for the rest of the plan year.

Prescription drug coverage is provided through a separate plan – UnitedHealthcare MedicareRx for Groups (PDP)

 

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.