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UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO)
- Monthly premium
- Primary care provider (PCP)
- Out-of-pocket maximum
Discover the Benefits
Dental benefits
- $2,000 dental allowance for covered preventive and comprehensive services like cleanings, fillings and crowns
OTC Credit
- $50 credit every quarter for OTC products like pain relievers, cold remedies and vitamins in-store or online
Routine vision benefits
- $0 copay for a routine eye exam and standard prescription lenses, plus $150 allowance for frames or contacts
General plan costs
See how much you'll pay for this plan including your premium, deductible and maximum out-of-pocket costs.
| Costs | In-network - What you'll pay | Out-of-network - What you'll pay |
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| Monthly premium | $0 | |
| Monthly premium $0$0 | ||
Medicare Part B premium giveback
Medicare Part B premium giveback
When you enroll in a UnitedHealthcare Medicare Advantage plan that offers the Medicare Part B premium giveback, UnitedHealthcare pays part of your Medicare Part B premium each month. The amount paid by UnitedHealthcare towards your Medicare Part B premium varies by plan.
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Up to $50 | |
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Medicare Part B premium giveback
Medicare Part B premium giveback
When you enroll in a UnitedHealthcare Medicare Advantage plan that offers the Medicare Part B premium giveback, UnitedHealthcare pays part of your Medicare Part B premium each month. The amount paid by UnitedHealthcare towards your Medicare Part B premium varies by plan.
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Annual medical deductible
Annual medical deductible
The pre-set, fixed amount you must pay for health care costs before the insurance company or Medicare begins to pay. Please see your Evidence of Coverage for details.
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No deductible | No deductible |
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Annual medical deductible
Annual medical deductible
The pre-set, fixed amount you must pay for health care costs before the insurance company or Medicare begins to pay. Please see your Evidence of Coverage for details.
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Out-of-pocket maximum
Out-of-pocket maximum
This is the highest amount of money you have to pay out of your pocket for cost sharing (copayments and coinsurance) charged for certain covered services during a calendar year. Not all copayments or coinsurance amounts you pay apply toward the annual out-of-pocket maximum. See the plan’s Evidence of Coverage for more information.
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$6,500 | $6,500 combined in and out-of-network |
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Out-of-pocket maximum
Out-of-pocket maximum
This is the highest amount of money you have to pay out of your pocket for cost sharing (copayments and coinsurance) charged for certain covered services during a calendar year. Not all copayments or coinsurance amounts you pay apply toward the annual out-of-pocket maximum. See the plan’s Evidence of Coverage for more information.
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National Network
National Network
As a member of an eligible health plan, the UnitedHealthcare Medicare National Network allows you to have access to participating care providers across the United States at your in-network cost share, even when getting care outside of your home location. Networks vary by market and exclusions may apply.
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Yes, you can get network care across the country | |
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National Network
National Network
As a member of an eligible health plan, the UnitedHealthcare Medicare National Network allows you to have access to participating care providers across the United States at your in-network cost share, even when getting care outside of your home location. Networks vary by market and exclusions may apply.
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Doctor visits
Find out about this plan's copays for primary care providers and specialists.
| Costs | In-network - what you'll pay | Out-of-network - what you'll pay |
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| Primary care provider (PCP) | $0 copay | $0 copay |
| Primary care provider (PCP) $0 copay$0 copay | ||
| Specialist | $45 copay | $45 copay |
| Specialist $45 copay$45 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 | $0 copay, combined visits in and out-of-network |
| Annual routine physical $0 copay, 1 per year$0 copay, combined visits in and out-of-network | ||
| Preventive services (such as covered screenings, vaccinations, etc.) | $0 copay for covered services | $0 copay for covered services |
| Preventive services (such as covered screenings, vaccinations, etc.) $0 copay for covered services$0 copay for covered services | ||
| Mental health (outpatient) |
Group: $15 copay Individual: $25 copay |
Group: $15 copay Individual: $25 copay |
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Mental health (outpatient)
Group: $15 copay Individual: $25 copay Group: $15 copay Individual: $25 copay |
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| Opioid treatment services | $0 copay | $0 copay |
| Opioid treatment services $0 copay$0 copay | ||
Dental coverage
Learn about this plan's dental coverage options and costs.
| Costs | What you'll pay |
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| Routine dental |
$2,000 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. |
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Routine dental
$2,000 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. |
Medical benefit information
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 |
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| 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 | $100 copay per visit ($0 copay when outside of the United States) | |
| Emergency care $100 copay per visit ($0 copay when outside of the United States)$100 copay per visit ($0 copay when outside of the United States) | ||
| Ambulance services | $290 copay for ground or air | $290 copay for ground or air |
| Ambulance services $290 copay for ground or air$290 copay for ground or air | ||
| Inpatient hospital care |
$350 copay per day: days 1-7 $0 copay per day after that for unlimited days |
$350 copay per day: days 1-7 $0 copay per day after that for unlimited days |
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Inpatient hospital care
$350 copay per day: days 1-7 $0 copay per day after that for unlimited days$350 copay per day: days 1-7 $0 copay per day after that for unlimited days |
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| Outpatient hospital services (including surgery and observation) | $325 copay | $325 copay |
| Outpatient hospital services (including surgery and observation) $325 copay$325 copay | ||
| Ambulatory surgical center | $300 copay | $325 copay |
| Ambulatory surgical center $300 copay$325 copay | ||
| Physical, speech or occupational therapy | $40 copay per visit | $40 copay per visit |
| Physical, speech or occupational therapy $40 copay per visit$40 copay per visit | ||
| Lab services | $0 copay | $0 copay |
| Lab services $0 copay$0 copay | ||
| Outpatient X-rays | $25 copay | $25 copay |
| Outpatient X-rays $25 copay$25 copay | ||
| Diagnostic tests and procedures, non-radiological (such as EKG/ECG tests, etc.) | $50 copay | $50 copay |
| Diagnostic tests and procedures, non-radiological (such as EKG/ECG tests, etc.) $50 copay$50 copay | ||
| Diagnostic radiology services (such as MRIs, CT scans, etc.) | $250 copay | $250 copay |
| Diagnostic radiology services (such as MRIs, CT scans, etc.) $250 copay$250 copay | ||
| Skilled nursing facility |
$0 copay per day: days 1-20 $203 copay per day: days 21-100 |
$0 copay per day: days 1-20 $203 copay per day: days 21-100 |
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Skilled nursing facility
$0 copay per day: days 1-20 $203 copay per day: days 21-100$0 copay per day: days 1-20 $203 copay per day: days 21-100 |
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| 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 | ||
Extra benefits and programs
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 |
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| Routine eye exam | $0 copay, 1 per year | $0 copay, combined visits in and out-of-network |
| Routine eye exam $0 copay, 1 per year$0 copay, combined visits in and out-of-network | ||
| Routine eyewear |
$0 copay Plan pays up to $150 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). |
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Routine eyewear
$0 copay Plan pays up to $150 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 $150 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). |
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| Routine hearing exam | $0 copay, 1 per year | $0 copay, combined visits in and out-of-network |
| Routine hearing exam $0 copay, 1 per year$0 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 | $50 credit per quarter to buy covered OTC products. | |
| OTC credit $50 credit per quarter to buy covered OTC products.$50 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 | $45 copay, 6 visits per year | $45 copay, combined visits in and out-of-network |
| Routine foot care $45 copay, 6 visits per year$45 copay, combined visits in and out-of-network | ||
| Meal benefit | $0 copay for 28 home-delivered meals immediately after an inpatient hospitalization or skilled nursing facility (SNF) stay. | |
| Meal benefit $0 copay for 28 home-delivered meals immediately after an inpatient hospitalization or skilled nursing facility (SNF) stay.$0 copay for 28 home-delivered meals immediately after an inpatient hospitalization or skilled nursing facility (SNF) stay. | ||
| 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. | ||
Plan documents
Important documents that provide the details you need about this plan's coverage and benefits, prescription drugs, enrollment, providers and more.
| General Plan Information |
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General Plan Information
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| Provider Directory | |
| Provider Directory |
| General Plan Information |
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General Plan Information
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| Provider Directory |
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Provider Directory
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Footnotes & disclaimers
Disclaimer information
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 plan’s 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.
Featured Benefits
- Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.
- 2024: 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.
- Eligibility for the healthy food and utilities benefit under the Value-Based Insurance Design model is limited to members with Extra Help from Medicare and will be determined after enrollment.
- For C-SNP: The healthy food benefit is a special supplemental benefit only available to chronically ill enrollees with a qualifying condition, such as diabetes, chronic heart failure and/or cardiovascular disorders, and who also meet all applicable plan coverage criteria. Contact us for details.
- For D-SNP, TN only: The healthy food benefit is a special supplemental benefit only available to chronically ill enrollees with a qualifying condition, such as high blood pressure, high cholesterol, chronic and disabling mental health conditions, diabetes and/or cardiovascular disorders, and who also meet all applicable plan coverage criteria. There may be other qualified conditions not listed. Contact us for details.
- 2024: 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 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.
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