Coverage and benefits

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

It’s Your Choice Medicare Advantage (PPO) plan

2024 materials

No deductible plan

Deductible plan

Medicare Plus plan by UnitedHealthcare (Senior Supplement)

2024 materials

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 - (IYC MA Plan only)
  • Screenings for certain Cancers (Prostate, colorectal, breast cancer)
  • Screening for diabetes
  • Smoking and Tobacco Use Cessation
  • Vaccinations

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

It’s Your Choice Medicare Advantage (PPO) plan – No deductible

It’s Your Choice Medicare Advantage (PPO) plan – With deductible

Medicare Plus plan by UnitedHealthcare (Senior Supplement)
Annual medical deductible

$0

$500

$0
Annual out-of-pocket maximum

$500 for Durable Medical Equipment (DME) $6,700* total for all Medicare expenses (includes DME out-of-pocket costs)

$500 for Durable Medical Equipment (DME) $6,700* total for all Medicare expenses (includes DME out-of-pocket costs)

$0
Office and clinic visits

$0 copay

$0 copay after deductible

$0 copay
Hospital services ( inpatient)

$0 copay

$0 copay after deductible

$0 copay
Hospital (outpatient)

$0 copay

$0 copay after deductible

$0 copay
Emergency room services

$60 copay

$60 copay after deductible

$0 copay

* Refer to your Prescription Drug Plan benefit details at
Benefits Available to Me | ETF (wi.gov) for more information on your annual maximum
out-of-pocket amount. Blood glucose monitor

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.