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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.
UnitedHealthcare® Group Medicare Advantage (HMO)
2024 materials
ASRS
Spanish
PSPRS
Spanish
UnitedHealthcare® Group Medicare Advantage (PPO)
2024 materials
ASRS
Spanish
PSPRS
Spanish
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 | UnitedHealthcare® Group Medicare Advantage (HMO) | UnitedHealthcare® Group Medicare Advantage (PPO) |
|---|---|---|
| Annual medical deductible | None | None |
| Annual out-of-pocket maximum | $4,000 | $5,000 |
| Office and clinic visits | $15 copay for primary care $30 copay for specialist visit |
$15 copay for primary care $25 copay for specialist visit |
| Hospital services (inpatient) | $100 copay per admission | $100 copay per admission |
| Hospital emergency services (outpatient) | $50 copay for each Medicare-covered emergency room visit (waived if admitted) $15 copay for each Medicare-covered urgently needed care visit |
$50 copay for each Medicare-covered emergency room visit (waived if admitted) $25 copay for each Medicare-covered urgently needed care visit |
| Prescription drug coverage | Retail (30-day supply) Tier 1: $10 copay Mail order (90-day supply) Tier 1: $20 copay The UnitedHealthcare® Group Medicare Advantage HMO plan offers additional coverage during the Coverage Gap stage of the Prescription Drug Plan. After your total drug costs reach $5,030, the plan continues to pay its share of the cost of your drugs and you pay your share of the cost (your copay) until you reach the Catastrophic Coverage stage. During the Catastrophic Coverage stage, the plan pays the full cost for your covered drugs. You pay nothing. Please see Plan guide for details. |
Retail (30-day supply) Tier 1: $10 copay Mail order (90-day supply) Tier 1: $20 copay The UnitedHealthcare® Group Medicare Advantage PPO plan offers standard coverage during the Coverage Gap stage of the Prescription Drug Plan. After your total drug costs reach $5,030, you pay 25% of the price for brand name and generic drugs until you reach the Catastrophic Coverage stage. During the Catastrophic Coverage stage, the plan pays the full cost for your covered drugs. You pay nothing. Please see Plan Guide for details. |
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.