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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® Group Medicare Advantage (PPO)
2022 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
| 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 |
$15 copay for each Medicare-covered urgently needed care visit |
| Prescription drug coverage | ||
|
$15 copay for each Medicare-covered urgently needed care visit |
$15 copay for each Medicare-covered urgently needed care visit |
|
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.