Coverage and benefits

Get a quick overview of your plan benefits and costs and find more detailed information about additional benefits and programs.

UnitedHealthcare® Group Medicare Advantage (HMO)

2022 materials

UnitedHealthcare® Group Medicare Advantage (PPO)

2022 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.

Benefits and costs

Benefits and costs
Benefit UnitedHealthcare® Group Medicare Advantage (HMO) UnitedHealthcare® Group Medicare Advantage (PPO)
Annual medical deductible None $150 deductible on first inpatient hospitalization annually
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 $0 after $150 annual inpatient deductible has been met
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
Tier 2: $40 copay
Tier 3: $40 copay
Tier 4: $40 copay

Mail order (90-day supply)

Tier 1: $20 copay
Tier 2: $80 copay
Tier 3: $80 copay
Tier 4: $80 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 $4,430, 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. Please see Plan guide for details.

Retail (30-day supply)

Tier 1: $10 copay
Tier 2: $35 copay
Tier 3: $35 copay
Tier 4: $35 copay

Mail order (90-day supply)

Tier 1: $20 copay
Tier 2: $70 copay
Tier 3: $70 copay
Tier 4: $70 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 $4,430, you pay 25% of the price for brand name and generic drugs until you reach the Catastrophic Coverage stage. 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.