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)
2022 materials
Benefits and costs
Benefit | UnitedHealthcare® Medicare Advantage (PPO) | |
---|---|---|
Part B premium subsidy | $50 per month | |
Annual medical deductible | None | |
Annual out-of-pocket maximum | None | |
Office and clinic visits | $0 copay for primary care, specialist visits or virtual visits/telemedicine | |
Hospital services (inpatient) | $0 copay | |
Hospital services (outpatient) | $0 copay | |
Ambulance services | $0 copay | |
Emergency room | $0 copay | |
Urgent care | $0 copay | |
Durable medical equipment | $0 copay | |
Prosthetics | $0 copay | |
Diabetic Supplies (test strips, lancets, glucose monitors) | $0 copay | |
Preventive services | $0 copay | |
Routine podiatry | $0 copay – 6 per year | |
Hearing aid allowance | $0 copay 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. | ||
Prescription drug coverage | Retail (Note: 90-day retail supply is available for 3x copay amount) Tier 1 (Generic): $10 copay Mail Order (up to 90-day supply) Tier 1 (Generic): $20 copay |
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.
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.