Review plan benefits & costs
Get a quick overview of your plan options and their benefits and costs. You can also review more detailed information about additional coverage and benefit services the plans offer.
UnitedHealthcare® Group Medicare Advantage
(PPO) - Standard and Premium Plan
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.
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.
Want to know what's changed in your plan?
Review the previous year's plan materials »
|Benefits and costs||UnitedHealthcare® Group Medicare Advantage (PPO) Standard Plan||UnitedHealthcare® Group Medicare Advantage (PPO) Premium Plan|
|Annual medical deductible||None||None|
|Annual out-of-pocket maximum||$3,500||$2,500|
|Office and clinic visits||$25 copay primary care
$30 copay specialist visit
|$15 copay primary care
$25 copay specialist visit
|Hospital services (inpatient)||20% coinsurance per admit||20% coinsurance per admit|
|Hospital services (outpatient)||$95 copay (observation room)
$25 copay (PCP)
$30 copay (SPC)
|$50 copay (observation room)
$15 copay (PCP)
$25 copay (SPC)
|Urgent care||$25 copay||$20 copay|
|Emergency||$50 copay||$50 copay|
|Prescription drug coverage||
2022 Retiree Option Change Period (ROCP)
Begins: October 18, 2021,
at 12:00 a.m. ET
Ends: November 5, 2021,
11:59 p.m. ET
Need to RSVP for a meeting?
RSVP to reserve your space for one of the ROCP meetings
TTY users, call: 711
8:00 a.m. - 8:00 p.m. local time
Monday through Friday