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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.
2024 materials
UnitedHealthcare® Group Medicare Advantage (PPO)
UnitedHealthcare® Senior Supplement Plan
UnitedHealthcare® MedicareRx for Groups (PDP)
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
| Benefit |
UHC Group Medicare Advantage with Prescription Drug Coverage (PPO) |
Senior Supplement with Vision and Hearing, Plus Prescription Drug Plan |
|---|---|---|
|
UHC Group Medicare Advantage with Prescription Drug Coverage (PPO) |
Senior Supplement with Vision and Hearing, Plus Prescription Drug Plan |
|
| Annual medical deductible |
None |
*$240 |
| Annual medical deductible | ||
|
None |
*$240 |
|
| Annual out-of-pocket maximum |
2000 |
*$2,240 |
| Annual out-of-pocket maximum | ||
|
2000 |
*$2,240 |
|
| Office and clinic visits |
$10 copay |
$10 copay |
| Office and clinic visits | ||
|
$10 copay |
$10 copay |
|
| Hospital services (inpatient) |
$200 copay per admit |
$250 copay per admit |
| Hospital services (inpatient) | ||
|
$200 copay per admit |
$250 copay per admit |
|
| Hospital services (outpatient) |
$10 copay |
$0 Non Surgery copay $100 Surgical |
| Hospital services (outpatient) | ||
|
$10 copay |
$0 Non Surgery copay $100 Surgical |
|
| Vision |
Routine Eye Exam for Refraction (every 12-months): $10 copay Eyeglasses and Contact Lenses (every 24 months): $240 allowance |
Routine Eye Exam for Refraction (every 12-months): $0 copay Eyeglasses and Contact Lenses (every 24 months): $240 allowance |
| Vision | ||
|
Routine Eye Exam for Refraction (every 12-months): $10 copay Eyeglasses and Contact Lenses (every 24 months): $240 allowance |
Routine Eye Exam for Refraction (every 12-months): $0 copay Eyeglasses and Contact Lenses (every 24 months): $240 allowance |
|
| Hearing |
Routine Hearing Exam (every year): $0 Hearing Aid Allowance: $1,500 every 3 years, combined for both ears Hearing aids purchased outside of UnitedHealthcare Hearing’s nationwide network are NOT covered. |
Routine Hearing Exam (every year): $0 Hearing Aid Allowance: $5,000 every 2 years, combined for both ears Hearing aids purchased outside of UnitedHealthcare Hearing’s nationwide network are NOT covered. |
| Hearing | ||
|
Routine Hearing Exam (every year): $0 Hearing Aid Allowance: $1,500 every 3 years, combined for both ears Hearing aids purchased outside of UnitedHealthcare Hearing’s nationwide network are NOT covered. |
Routine Hearing Exam (every year): $0 Hearing Aid Allowance: $5,000 every 2 years, combined for both ears Hearing aids purchased outside of UnitedHealthcare Hearing’s nationwide network are NOT covered. |
|
| Prescription drug coverage |
Retail Tier 1: 5% Tier 2: 20% Tier 3: 30% Tier 4: 30%
Mail Order Tier 1: 5% Tier 2: 20% Tier 3: 30% Tier 4: 30% |
Retail Tier 1: 5% Tier 2: 20% Tier 3: 30% Tier 4: 30%
Mail Order Tier 1: 5% Tier 2: 20% Tier 3: 30% Tier 4: 30%
|
| Prescription drug coverage | ||
|
Retail Tier 1: 5% Tier 2: 20% Tier 3: 30% Tier 4: 30%
Mail Order Tier 1: 5% Tier 2: 20% Tier 3: 30% Tier 4: 30% |
Retail Tier 1: 5% Tier 2: 20% Tier 3: 30% Tier 4: 30%
Mail Order Tier 1: 5% Tier 2: 20% Tier 3: 30% Tier 4: 30%
|
|
| Rx Deductible |
$200 |
$200 |
| Rx Deductible | ||
|
$200 |
$200 |
|
| Rx Maxium Out of Pocket |
$3,500 |
$3,500 |
| Rx Maxium Out of Pocket | ||
|
$3,500 |
$3,500 |
|
*2024 CMS Data
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.