Coverage and benefits

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

Compass Rose Medicare Advantage Plan (PPO)

2025 materials

Benefits and costs

Plan options and costs
Benefits and costs

Compass Rose Medicare Advantage Plan

Compass Rose Medicare Advantage Plan
Part B premium reduction

$125 per month
Part B premium reduction

$125 per month
Annual medical deductible

None
Annual medical deductible

None
Annual out-of-pocket maximum

None
Annual out-of-pocket maximum

None
Office and clinic visits

$0 copay for primary care, specialist or Virtual Visit/Telemedicine
Office and clinic visits

$0 copay for primary care, specialist or Virtual Visit/Telemedicine
Hospital services (inpatient)

$0 copay
Hospital services (inpatient)

$0 copay
Hospital services (outpatient)

$0 copay
Hospital services (outpatient)

$0 copay
Ambulance services

$0 copay
Ambulance services

$0 copay
Emergency room

$0 copay
Emergency room

$0 copay
Urgent care

$0 copay
Urgent care

$0 copay
Durable medical equipment

$0 copay
Durable medical equipment

$0 copay
Prosthetics

$0 copay
Prosthetics

$0 copay
Diabetic supplies (test strips, lancets, glucose monitors)

$0 copay
Diabetic supplies (test strips, lancets, glucose monitors)

$0 copay
Preventive services

$0 copay
Preventive services

$0 copay
Routine podiatry

$0 copay - 6 visits per year
Routine podiatry

$0 copay - 6 visits per year
Massage therapy

$0 copay

$60 allowance per visit
Massage therapy

$0 copay

$60 allowance per visit
Hearing aid allowance

$0 copay - $2,400 allowance for unlimited aids every 3 years. Allowance is combined for both ears.

You must contact UnitedHealthcare hearing prior to using your hearing aid allowance. Hearing aids ordered through providers other than UnitedHealthcare Hearing are not covered.
Hearing aid allowance

$0 copay - $2,400 allowance for unlimited aids every 3 years. Allowance is combined for both ears.

You must contact UnitedHealthcare hearing prior to using your hearing aid allowance. Hearing aids ordered through providers other than UnitedHealthcare Hearing are not covered.
Dental

Class 1 Preventive & Diagnostic (P&D): $0 copay

Class 2 Minor: 20% copay

Class 3 Major: 50% copay

Deductible (P&D not included): $50

Annual Plan Year Maximum (P&D not included): $1,000

Out-of-network reimbursement schedule: Maximum Allowable Charge
Dental

Class 1 Preventive & Diagnostic (P&D): $0 copay

Class 2 Minor: 20% copay

Class 3 Major: 50% copay

Deductible (P&D not included): $50

Annual Plan Year Maximum (P&D not included): $1,000

Out-of-network reimbursement schedule: Maximum Allowable Charge
Vision

Routine Eye Exam Refraction: $0 copay – 1 per 12 months

Eyeglasses Allowance: $130 every 12 months

Contact Lens Allowance (in lieu of glasses): $175 every 12 months
Vision

Routine Eye Exam Refraction: $0 copay – 1 per 12 months

Eyeglasses Allowance: $130 every 12 months

Contact Lens Allowance (in lieu of glasses): $175 every 12 months
Prescription drug coverage

Part D Retail Copay (up to a 30-day supply) 

Note: 90-day Retail supply for Tiers 1-3 is available for the same copay amount as Mail Order; Tier 4 is limited to a 30-day supply

 

Tier 1: Generic $1 copay 

Tier 2: Preferred Brand $25 copay

Tier 3: Non-Preferred Brand $75 copay

Tier 4: Specialty Tier – Limited to a 30-day supply 25% ($100 maximum)

 

Part D Preferred Mail Order Copay *

(up to a 90-day supply for Tiers 1-3; Tier 4 is limited to a 30-day supply)

 

Tier 1: Generic $2 copay 

Tier 2: Preferred Brand $50 copay

Tier 3: Non-Preferred Brand $150 copay

Tier 4: Specialty Tier – Limited to a 30-day supply 25% ($100 maximum) 

*UnitedHealthcare’s pharmacy benefit manager is OptumRX. Mail order prescriptions will be through OptumRX. 
Prescription drug coverage

Part D Retail Copay (up to a 30-day supply) 

Note: 90-day Retail supply for Tiers 1-3 is available for the same copay amount as Mail Order; Tier 4 is limited to a 30-day supply

 

Tier 1: Generic $1 copay 

Tier 2: Preferred Brand $25 copay

Tier 3: Non-Preferred Brand $75 copay

Tier 4: Specialty Tier – Limited to a 30-day supply 25% ($100 maximum)

 

Part D Preferred Mail Order Copay *

(up to a 90-day supply for Tiers 1-3; Tier 4 is limited to a 30-day supply)

 

Tier 1: Generic $2 copay 

Tier 2: Preferred Brand $50 copay

Tier 3: Non-Preferred Brand $150 copay

Tier 4: Specialty Tier – Limited to a 30-day supply 25% ($100 maximum) 

*UnitedHealthcare’s pharmacy benefit manager is OptumRX. Mail order prescriptions will be through OptumRX. 
Annual prescription (Part D) out-of-pocket maximum

$2,000

Once your True Out of Pocket (TROOP) reaches $2,000 you enter the Catastrophic Coverage level and will have no copay for all covered medications.
Annual prescription (Part D) out-of-pocket maximum

$2,000

Once your True Out of Pocket (TROOP) reaches $2,000 you enter the Catastrophic Coverage level and will have no copay for all covered medications.

Important 2025 changes explained

For 2025, all stand-alone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage will be impacted by changes made by the federal government. This video provides an overview of those changes.

Learn more

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.

 

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 UCard.