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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.
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 with Prescription Drug Plan
2024 materials
Plan materials
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 | UnitedHealthcare® Group Medicare Advantage PPO with Prescription Drug Plan |
|---|---|
| Annual medical deductible | $0 |
| Annual out-of-pocket maximum | $3,000 |
| Office and clinic visits | $15 copay for primary care $25 copay for specialist visit |
| Hospital services (inpatient) | $250 copay per admit |
| Hospital services (outpatient) | 20% coinsurance |
| Emergency room | $120 copay (waived if admitted) |
| Urgent care | $35 copay (waived if admitted) |
| Ambulance | $150 copay |
| Skilled nursing facility | $0 copay days 1 – 20 $80/day copay days 21 – 100 |
| Prescription drug coverage | Retail Mail Order Optum Rx is an affiliate of UnitedHealthcare Insurance Company. You are not required to use Optum Rx home delivery for a 90-100 day supply of your maintenance medication. |
| Rx Maximum Out of Pocket | $2,950 |
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.