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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.
UnitedHealthcare® Medicare Advantage (PPO) for APWU Health Plan
Benefits and costs
| Benefits |
APWU Medicare Advantage Plan |
|---|---|
|
APWU Medicare Advantage Plan |
|
| Part B premium subsidy |
$85 per month |
| Part B premium subsidy | |
|
$85 per month |
|
| Annual medical deductible |
None |
| Annual medical deductible | |
|
None |
|
| Annual out-of-pocket maximum |
None |
| Annual out-of-pocket maximum | |
|
None |
|
| Office and clinic visits |
$0 copay for primary care, specialist visits or virtual visits/telemedicine |
| Office and clinic visits | |
|
$0 copay for primary care, specialist visits or virtual visits/telemedicine |
|
| Hospital services (inpatient) |
$0 copay |
| Hospital services (inpatient) | |
|
$0 copay |
|
| Hospital services (outpatient) |
$0 copay |
| Hospital services (outpatient) | |
|
$0 copay |
|
| Ambulance services |
$0 copay |
| Ambulance services | |
|
$0 copay |
|
| Emergency room |
$0 copay |
| Emergency room | |
|
$0 copay |
|
| Urgent care |
$0 copay |
| Urgent care | |
|
$0 copay |
|
| Durable medical equipment |
$0 copay |
| Durable medical equipment | |
|
$0 copay |
|
| Prosthetics |
$0 copay |
| Prosthetics | |
|
$0 copay |
|
| Diabetic Supplies (test strips, lancets, glucose monitors) |
$0 copay |
| Diabetic Supplies (test strips, lancets, glucose monitors) | |
|
$0 copay |
|
| Preventive services |
$0 copay |
| Preventive services | |
|
$0 copay |
|
| Routine podiatry |
$0 copay – 6 per year |
| Routine podiatry | |
|
$0 copay – 6 per year |
|
| Hearing aid allowance |
$0 copay $1,500 allowance for unlimited aids every 3 years. Allowance is combined for both ears.
Note: You must contact UnitedHealthcare Hearing prior to using your hearing aid allowance. Hearing aids ordered through providers other than UnitedHealthcare Hearing are not covered. |
| Hearing aid allowance | |
|
$0 copay $1,500 allowance for unlimited aids every 3 years. Allowance is combined for both ears.
Note: You must contact UnitedHealthcare Hearing prior to using your hearing aid allowance. Hearing aids ordered through providers other than UnitedHealthcare Hearing are not covered. |
|
| Dental |
Class 1 Preventive & Diagnostic (P&D) 100% Class 2 Minor 80% Class 3 Major 50% Deductible (P&D not included) $50 Annual Calendar Maximum $1,000 Out-of-Network Reimbursement Schedule Maximum Allowable Charge Note: preventive and diagnostic services do not apply to the annual maximum. |
| Dental | |
|
Class 1 Preventive & Diagnostic (P&D) 100% Class 2 Minor 80% Class 3 Major 50% Deductible (P&D not included) $50 Annual Calendar Maximum $1,000 Out-of-Network Reimbursement Schedule Maximum Allowable Charge Note: preventive and diagnostic services do not apply to the annual maximum. |
|
| Prescription drug coverage |
Retail (Note: 90-day retail supply is available for 3x copay amount) Tier 1 (Generic): $10 copay Tier 2 (Preferred Brand): $30 copay Tier 3 (Non-Preferred Brand): $45 copay Tier 4 (Specialty Tier): $60 copay Generic oral diabetic medications: $0 copay
Mail Order (up to 90-day supply) Tier 1 (Generic): $20 copay Tier 2 (Preferred Brand): $60 copay Tier 3 (Non-Preferred Brand): $90 copay Tier 4 (Specialty Tier): $120 copay |
| Prescription drug coverage | |
|
Retail (Note: 90-day retail supply is available for 3x copay amount) Tier 1 (Generic): $10 copay Tier 2 (Preferred Brand): $30 copay Tier 3 (Non-Preferred Brand): $45 copay Tier 4 (Specialty Tier): $60 copay Generic oral diabetic medications: $0 copay
Mail Order (up to 90-day supply) Tier 1 (Generic): $20 copay Tier 2 (Preferred Brand): $60 copay Tier 3 (Non-Preferred Brand): $90 copay Tier 4 (Specialty Tier): $120 copay |
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.
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.