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 (PPO)

2025 materials

Standard plan

Standard plan

Standard plan

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

Plan options and costs
Benefit

UnitedHealthcare® Group Medicare Advantage (HMO)

UnitedHealthcare® Group Medicre Advantage (PPO)

UnitedHealthcare® Group Medicare Advantage (HMO)

UnitedHealthcare® Group Medicre Advantage (PPO)
Annual medical deductible

None

$1500 deductible on first inpatient hospitalization annually
Annual medical deductible

None

$1500 deductible on first inpatient hospitalization annually
Annual out-of-pocket maximum

$4,000

$5, 000
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
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 services (inpatient)

$100 copay per admission

$0 after $150 annual inpatient deductible has been met
Hospital services (outpatient)

$50 copay for each Medicare-covered emergency room visit (waived if admitted)

$50 copay for each Medicare-covered emergency room visit (waived if admitted)
Hospital services (outpatient)

$50 copay for each Medicare-covered emergency room visit (waived if admitted)

$50 copay for each Medicare-covered emergency room visit (waived if admitted)
Prescription drug coverage

$15 copay for each Medicare-covered urgently needed care visit
$10 copay generic Tier 1
$20 coapy generic Tier 1 mail-order

$15 copay for each Medicare-covered urgently needed care visit
$10 copay generic Tier 1
$20 coapy generic Tier 1 mail-order
Prescription drug coverage

$15 copay for each Medicare-covered urgently needed care visit
$10 copay generic Tier 1
$20 coapy generic Tier 1 mail-order

$15 copay for each Medicare-covered urgently needed care visit
$10 copay generic Tier 1
$20 coapy generic Tier 1 mail-order

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 cost sharing that applies to out-of-network services.