AARP Medicare Advantage from UHC OH-0016 (PPO)
Health Insurance Company: UnitedHealthcareⓇ
Medicare Advantage Plan Details
- Rx
- Dental
- Vision
- Hearing
General Plan Details
Additional Benefits
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Mon-Fri: 8am-9pm, Sat: 8am-8pm ETNo Obligation to EnrollDoctor & Hospital Coverage
Out-of-network: $20 copay per visit
Out-of-network: $80 copay per visit
Out-of-network: 0-40% coinsurance
Emergency Room
$125 copay per visit (always covered)
Ambulance Coverage
In-network: $275 copay
Out-of-network: $275 copay
Lab, X-Ray, Radiology Coverage
Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: $50 copay
Out-of-network: 40% coinsurance
Medicare-covered lab services: In-network: $0 copay
Out-of-network: $0 copay
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $0-150 copay
Out-of-network: 40% coinsurance
Medicare-covered x-ray services: In-network: $20 copay
Out-of-network: $40 copay
Outpatient Surgery Coverage
Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: $0-375 copay per visit
Out-of-network: $375 copay per visit
Hospitalization Coverage
Inpatient hospital-acute:
In-network: $375 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: $545 per day for days 1 through 10
$0 per day for days 11 and beyond
Inpatient hospital psychiatric:
In-network: $375 per day for days 1 through 4
$0 per day for days 5 through 90
Out-of-network: $545 per day for days 1 through 10
$0 per day for days 11 through 90
Rehabilitation Coverage
Occupational therapy services:
In-network: $0-40 copay
Out-of-network: $80 copay
Physical therapy and speech and language therapy services:
In-network: $0-40 copay
Out-of-network: $80 copay
Urgent Care Coverage
$0-55 copay per visit (always covered)
Skilled Nursing Facility (SNF)
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Out-of-network: $225 per day for days 1 through 100
Mental Health Coverage
Medicare-covered individual sessions: In-network: $0-25 copay
Out-of-network: $40 copay
Medicare-covered group sessions: In-network: $15 copay
Out-of-network: $30 copay
Dental, Vision, Hearing Benefits
Dental Services
Oral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay
Vision Benefits
Eye exams:
Routine eye exams: In-network: $0 copay
Out-of-network: $80 copay
Eyewear:
Contact Lenses: In-network: $0 copay
Out-of-network: $0-153 copay
Eyeglasses: Not covered
Hearing Benefits
Hearing exams:
Routine hearing exams: In-network: $0 copay
Out-of-network: $80 copay
Hearing aids:
Hearing aids (all types): In-network: $199-1,249 copay
Out-of-network: $199-1,249 copay
Rx Drug Coverage - Standard Retail Cost
Tier 1: Preferred Generic
$0.00 copay (30-day supply)
$0.00 copay (90-day supply)
Tier 2: Generic
$12.00 copay (30-day supply)
$36.00 copay (90-day supply)
Tier 3: Preferred Brand
$47.00 copay (30-day supply)
$141.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
$100.00 copay (30-day supply)
Tier 5: Specialty Tier
28% coinsurance (30-day supply)
Rx Drug Coverage - Standard Mail Order Cost
Tier 1: Preferred Generic
$0.00 copay (90-day supply)
Tier 2: Generic
$36.00 copay (90-day supply)
Tier 3: Preferred Brand
$141.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
$100.00 copay (30-day supply)
Tier 5: Specialty Tier
28% coinsurance (30-day supply)
Rx Drug Coverage - Preferred Mail Order Cost
Tier 1: Preferred Generic
$0.00 copay (90-day supply)
Tier 2: Generic
$0.00 copay (90-day supply)
Tier 3: Preferred Brand
$131.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
$100.00 copay (30-day supply)
Tier 5: Specialty Tier
28% coinsurance (30-day supply)
More Additional Benefits
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Where This Plan is Available
Additional Plan Info
- Estimated annual savings is determined by subtracting a plan's annual cost estimate of the medications entered from the medications' average retail prices. The annual cost estimate for a plan includes covered annual monthly premiums and any annual cost sharing expenses that you must pay out-of-pocket for the medications entered. This number can only be calculated if the consumer enters medication information.
- The savings number is calculated from all of the saved sessions where another consumer entered medication information and their current plan. For each saved session, we calculate the cost of each plan based on the medication entered and geographical location. The savings number is derived by comparing the cost of the plan to the cheapest plan in that geographical location and taking the average.
- The retail drug cost is an estimated amount based on the out-of-pocket expenses you may expect to pay in a calendar year for medications that are not covered by an insurance plan's formulary on estimated retail drug price (retail drug cost is based on national averages for a medication and assumes adherence).
- If you need help, please call 1-888-296-0117 (TTY User: 711) Mon - Fri, 8am - 9pm ET for Customer Service Representatives and licensed insurance agents who can assist with finding information on available Medicare Advantage, Medicare Supplement Insurance and Prescription Drug Plans.
- For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
- You must have both Part A and B to enroll in a Medicare Advantage plan. Members may enroll in the plan only during specific times of the year. Contact the plan for more information.
- You must have Medicare Part A or Part B (or both) to join a Medicare Prescription Drug plan. Members may enroll in the plan only during specific times of the year. Contact the plan for more information.
- For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778 or consult www.socialsecurity.gov; or your Medicaid Office.
- Every year, Medicare evaluates plans based on a 5-star rating system.
- Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days a week or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696 (or equivalent written notice).
- Other Pharmacies, Physicians, and Providers are available in the network.
- Pharmacies, Physicians, and Providers may also contract with other Plan Sponsors.
- Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call the Plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
- The purpose of this communication is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. For Medicare Supplement Insurance Only: Open enrollment lasts 6 months and begins the first day of the month in which you are 65 or older and enrolled in Medicare Part B. Some states have an open enrollment period for eligible individuals under the age of 65, and a second enrollment period when they turn 65. If you are under 65, check with your state insurance department for guidelines.
- Under a contractual relationship between our insurance agency partners and each insurance company issuing a policy offered by our agency partners, our agency partners earn a commission paid by the insurance company for each policy the agency partner sells. The commission rate varies by policy and may increase as the agency partner sells more policies. In some cases, our agency partners may earn bonus commission amounts based on criteria such as the number of policies sold.
- Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
- Partner Disclosure: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.
For more information on Low-Income Subsidy — Medicare Extra Help Program, please visit:
https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-of-extra-help-part-d
https://www.ssa.gov/benefits/medicare/prescriptionhelp.html