Find out about this planâs copays for primary care providers and specialists.
Costs | In-network - what you'll pay | Out-of-network - what you'll pay |
---|---|---|
Primary care provider (PCP) | $0 copay | $20 copay |
Primary care provider (PCP) $0 copay$20 copay | ||
Specialist | $30 copay | $50 copay |
Specialist $30 copay$50 copay | ||
Virtual visits | $0 copay to talk with a telehealth provider online through live audio and video. | |
Virtual visits $0 copay to talk with a telehealth provider online through live audio and video.$0 copay to talk with a telehealth provider online through live audio and video. | ||
Annual routine physical | $0 copay, 1 per year | 30% of the cost, combined visits in and out-of-network |
Annual routine physical $0 copay, 1 per year30% of the cost, combined visits in and out-of-network | ||
Preventive services (such as covered screenings, vaccinations, etc.) | $0 copay for covered services | $0 copay - 30% of the cost (depending on the service) |
Preventive services (such as covered screenings, vaccinations, etc.) $0 copay for covered services$0 copay - 30% of the cost (depending on the service) | ||
Mental health (outpatient) |
Group: $15 copay Individual: $25 copay |
Group: $30 copay Individual: $40 copay |
Mental health (outpatient)
Group: $15 copay Individual: $25 copay Group: $30 copay Individual: $40 copay |
||
Opioid treatment services | $0 copay | $0 copay |
Opioid treatment services $0 copay$0 copay |
Learn about this planâs dental coverage options and costs.
Costs | What you'll pay |
---|---|
Routine dental |
$3,000 per year for covered dental services $0 copay for covered network preventive services such as oral exams, routine cleanings, X-rays and fluoride 50% coinsurance for bridges and dentures, $0 copay for all other covered network comprehensive services such as fillings, crowns, root canals and extractions You will have access to Medicare Advantage's largest dental network, or you can choose any dentist. Seeing a network dentist may save you money. |
Routine dental
$3,000 per year for covered dental services $0 copay for covered network preventive services such as oral exams, routine cleanings, X-rays and fluoride 50% coinsurance for bridges and dentures, $0 copay for all other covered network comprehensive services such as fillings, crowns, root canals and extractions You will have access to Medicare Advantage's largest dental network, or you can choose any dentist. Seeing a network dentist may save you money. |
See this plan's benefits, costs and copays. For full plan details, see the Evidence of Coverage or Summary of Benefits under the Plan Documents section.
Costs | In-network - What you'll pay | Out-of-network - What you'll pay |
---|---|---|
Urgent care | $40 copay per visit ($0 copay when outside of the United States) | |
Urgent care $40 copay per visit ($0 copay when outside of the United States)$40 copay per visit ($0 copay when outside of the United States) | ||
Emergency care | $120 copay per visit ($0 copay when outside of the United States) | |
Emergency care $120 copay per visit ($0 copay when outside of the United States)$120 copay per visit ($0 copay when outside of the United States) | ||
Ambulance services | $275 copay for ground or air | $275 copay for ground or air |
Ambulance services $275 copay for ground or air$275 copay for ground or air | ||
Inpatient hospital care |
$195 copay per day: days 1-6 $0 copay per day after that for unlimited days |
30% per stay for unlimited days |
Inpatient hospital care
$195 copay per day: days 1-6 $0 copay per day after that for unlimited days30% per stay for unlimited days |
||
Outpatient hospital services (including surgery and observation) | $195 copay | 30% of the cost |
Outpatient hospital services (including surgery and observation) $195 copay30% of the cost | ||
Ambulatory surgical center | $195 copay | 30% of the cost |
Ambulatory surgical center $195 copay30% of the cost | ||
Physical, speech or occupational therapy | $30 copay per visit | $50 copay per visit |
Physical, speech or occupational therapy $30 copay per visit$50 copay per visit | ||
Lab services | $0 copay | $0 copay |
Lab services $0 copay$0 copay | ||
Outpatient X-rays | $15 copay | $20 copay |
Outpatient X-rays $15 copay$20 copay | ||
Diagnostic tests and procedures, non-radiological (such as EKG/ECG tests, etc.) | $20 copay | 30% of the cost |
Diagnostic tests and procedures, non-radiological (such as EKG/ECG tests, etc.) $20 copay30% of the cost | ||
Diagnostic radiology services (such as MRIs, CT scans, etc.) | $225 copay | 30% of the cost |
Diagnostic radiology services (such as MRIs, CT scans, etc.) $225 copay30% of the cost | ||
Skilled nursing facility |
$0 copay per day: days 1-20 $203 copay per day: days 21-100 |
$225 copay per day: days 1-43 $0 copay per day: days 44-100 |
Skilled nursing facility
$0 copay per day: days 1-20 $203 copay per day: days 21-100$225 copay per day: days 1-43 $0 copay per day: days 44-100 |
||
Home health care | $0 copay | 50% of the cost |
Home health care $0 copay50% of the cost | ||
Diabetes monitoring supplies | $0 copay for covered brands | 50% of the cost |
Diabetes monitoring supplies $0 copay for covered brands50% of the cost |
See more of the benefits and programs offered by this plan that are not provided under Original Medicare. For full plan details, see the Evidence of Coverage or Summary of Benefits under the Plan Documents section.
Costs | In-network - What you'll pay | Out-of-network - What you'll pay |
---|---|---|
Routine eye exam | $0 copay, 1 per year | $50 copay, combined visits in and out-of-network |
Routine eye exam $0 copay, 1 per year$50 copay, combined visits in and out-of-network | ||
Routine eyewear |
$0 copay Plan pays up to $200 every year for frames or contact lenses. Standard single, bifocal, trifocal, or progressive lenses are covered in full. Home-delivered eyewear available nationwide only through UnitedHealthcare Vision (select products only). |
|
Routine eyewear
$0 copay Plan pays up to $200 every year for frames or contact lenses. Standard single, bifocal, trifocal, or progressive lenses are covered in full. Home-delivered eyewear available nationwide only through UnitedHealthcare Vision (select products only).$0 copay Plan pays up to $200 every year for frames or contact lenses. Standard single, bifocal, trifocal, or progressive lenses are covered in full. Home-delivered eyewear available nationwide only through UnitedHealthcare Vision (select products only). |
||
Routine hearing exam | $0 copay, 1 per year | $50 copay, combined visits in and out-of-network |
Routine hearing exam $0 copay, 1 per year$50 copay, combined visits in and out-of-network | ||
Hearing aids | Copays from $99 - $1,249 for a broad selection of OTC and brand-name prescription hearing aids through UnitedHealthcare Hearing, up to 2 hearing aids every year | |
Hearing aids Copays from $99 - $1,249 for a broad selection of OTC and brand-name prescription hearing aids through UnitedHealthcare Hearing, up to 2 hearing aids every yearCopays from $99 - $1,249 for a broad selection of OTC and brand-name prescription hearing aids through UnitedHealthcare Hearing, up to 2 hearing aids every year | ||
OTC credit | $75 credit per quarter to buy covered OTC products. | |
OTC credit $75 credit per quarter to buy covered OTC products.$75 credit per quarter to buy covered OTC products. | ||
Fitness program | $0 copay for Renew Active®, which includes a free gym membership, plus online fitness classes and brain health challenges. | |
Fitness program $0 copay for Renew Active®, which includes a free gym membership, plus online fitness classes and brain health challenges.$0 copay for Renew Active®, which includes a free gym membership, plus online fitness classes and brain health challenges. | ||
Routine foot care | $30 copay, 6 visits per year | $50 copay, combined visits in and out-of-network |
Routine foot care $30 copay, 6 visits per year$50 copay, combined visits in and out-of-network | ||
Meal benefit | $0 copay; coverage for at-home meal benefit from the network meal provider after an eligible hospital stay. Restrictions apply. | |
Meal benefit $0 copay; coverage for at-home meal benefit from the network meal provider after an eligible hospital stay. Restrictions apply.$0 copay; coverage for at-home meal benefit from the network meal provider after an eligible hospital stay. Restrictions apply. | ||
Personal emergency response system (PERS) | $0 copay for a PERS monitoring device that can quickly connect you to the help you need, 24 hours a day. | |
Personal emergency response system (PERS) $0 copay for a PERS monitoring device that can quickly connect you to the help you need, 24 hours a day.$0 copay for a PERS monitoring device that can quickly connect you to the help you need, 24 hours a day. | ||
Nurse Hotline | Speak with a registered nurse (RN) 24 hours a day, 7 days a week. | |
Nurse Hotline Speak with a registered nurse (RN) 24 hours a day, 7 days a week.Speak with a registered nurse (RN) 24 hours a day, 7 days a week. |
Important documents that provide the details you need about this plan's coverage and benefits, prescription drugs, enrollment, providers and more.
General Plan Information |
|
---|---|
General Plan Information
|
|
Provider Directory | |
Provider Directory |
General Plan Information |
|
---|---|
General Plan Information
|
|
Provider Directory |
|
Provider Directory
|
Dental, Ancilliary Mention:
Provider network may vary in local market. Dental network size based on Zelis Network360, May 2023.
Enrollment Disclaimer Information:
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the planâs contract renewal with Medicare. UnitedHealthcare Insurance Company paid royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll. AARP encourages you to consider your needs when selecting products and does not make specific product or pharmacy recommendations for individuals. UnitedHealthcare contracts directly with Walgreens for this plan; AARP and its affiliates are not parties to that contractual relationship.
Marketing Bullets:
- Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.
- Nurse Hotline not for use in emergencies, for informational purposes only.
- Other hearing exam providers are available in the UnitedHealthcare network. The plan only covers hearing aids from a UnitedHealthcare Hearing network provider.
- For Chronic Special Needs Plans - You will pay a maximum of $25 for each 1-month supply of Part D covered insulin drug through all coverage stages, except the Catastrophic drug payment stage where you pay $0.
- For All Other Plans - You will pay a maximum of $35 for each 1-month supply of Part D covered insulin drug through all coverage stages, except the Catastrophic drug payment stage where you pay $0.
- Food, OTC and utility benefits have expiration timeframes. Call your plan or review your Evidence of Coverage (EOC) for more information.
- You must have a working landline and/or cellular phone coverage to use PERS.
- The fitness benefit includes a standard fitness membership. The information provided is for informational purposes only and is not medical advice. Consult your doctor prior to beginning an exercise program or making changes to your lifestyle or health care routine. Gym network may vary in local market and plan.
- If your plan offers out-of-network dental coverage and you see an out-of-network dentist, you might be billed more. Network size varies by local market.
- Routine transportation not for use in emergencies.
- Virtual visits may require video-enabled smartphone or other device. Not for use in emergencies. Not all network providers offer virtual care.
- $0 copays may be restricted to preferred home delivery prescriptions during the initial coverage phase and may not apply during the coverage gap or catastrophic stage. Optum® Home Delivery Pharmacy and Optum Rx are affiliates of the UnitedHealthcare Insurance Company. You are not required to use Optum Home Delivery Pharmacy for medications you take regularly. There may be other pharmacies in your network.
Other Languages:
This information is available for free in other languages. Please contact Customer Service for additional information.â¯
Esta información está disponible sin costo en otros idiomas. Para obtener más información comunÃquese con nuestro Servicio al Cliente.â¯
æ¬è³è¨å¯ä»¥å
¶ä»èªè¨å
è²»æä¾ãå¦éæ´å¤è³è¨ï¼è«è¯çµ¡å®¢æ¶æåé¨ãâ¯
Get one-on-one help from UnitedHealthcare.