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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)
2026 materials
Medical Plan materials
Part D Plan materials
Starting in 2026, medical and prescription coverage will be managed through two separate plans. Due to this change, you will not receive an Annual Notice of Change (ANOC) this year. Plan materials, including your Evidence of Coverage (EOC), are available anytime in your member portal or by calling UnitedHealthcare.
For benefit questions, use the Chat Now feature or call 1-877-852-0641 (TTY 711).
| Medical Benefits and Costs |
Enhanced UnitedHealthcare Medicare Advantage (PPO) Plan |
Essential UnitedHealthcare Medicare Advantage (PPO) Plan |
|---|---|---|
|
Enhanced UnitedHealthcare Medicare Advantage (PPO) Plan |
Essential UnitedHealthcare Medicare Advantage (PPO) Plan |
|
| Annual medical deductible |
$0 |
$0 |
| Annual medical deductible | ||
|
$0 |
$0 |
|
| Annual out-of-pocket maximum |
$750 |
$5,000 |
| Annual out-of-pocket maximum | ||
|
$750 |
$5,000 |
|
| Premium information | ||
| Premium information | ||
| Office and clinic visits |
$5 copay for primary $30 for specialist |
$10 copay for primary $40 for specialist |
| Office and clinic visits | ||
|
$5 copay for primary $30 for specialist |
$10 copay for primary $40 for specialist |
|
| Hospital services (inpatient) |
$250 copay per stay |
$275 copay per day: days 1–5 $0 copay per day after that |
| Hospital services (inpatient) | ||
|
$250 copay per stay |
$275 copay per day: days 1–5 $0 copay per day after that |
|
| Hospital services (outpatient) |
$100 copay |
$275 copay |
| Hospital services (outpatient) | ||
|
$100 copay |
$275 copay |
|
| Part D Benefits and Costs |
Enhanced UnitedHealthcare® MedicareRx (PDP) |
Essential UnitedHealthcare® MedicareRx (PDP) |
|---|---|---|
|
Enhanced UnitedHealthcare® MedicareRx (PDP) |
Essential UnitedHealthcare® MedicareRx (PDP) |
|
| Prescription Drug |
Retail Tier 1: $0 copay Tier 2: $8 copay Tier 3: $40 copay Tier 4: $90 copay Tier 5: 30% coinsurance Mail Order Tier 1: $0 copay Tier 2: $16 copay Tier 3: $80 copay Tier 4: 180 copay Tier 5: 30% coinsurance |
Retail: $5 copay $15 copay $47 copay $100 copay 28% coinsurance Mail Order: $0 copay $37.50 copay $117.50 copay $250 copay 28% coinsurance |
| Prescription Drug | ||
|
Retail Tier 1: $0 copay Tier 2: $8 copay Tier 3: $40 copay Tier 4: $90 copay Tier 5: 30% coinsurance Mail Order Tier 1: $0 copay Tier 2: $16 copay Tier 3: $80 copay Tier 4: 180 copay Tier 5: 30% coinsurance |
Retail: $5 copay $15 copay $47 copay $100 copay 28% coinsurance Mail Order: $0 copay $37.50 copay $117.50 copay $250 copay 28% coinsurance |
|
| Annual prescription (Part D ) deductible |
$0 for Tier 1 and Tier 2 |
$0 for Tier 1 and Tier 2 |
| Annual prescription (Part D ) deductible | ||
|
$0 for Tier 1 and Tier 2 |
$0 for Tier 1 and Tier 2 |
|
| Premium information | ||
| Premium information | ||
For additional information on the IBM subsidy and how it applies to with these plan options refer to the Enrollment Brochure or call the IBM Retiree Call Center at 1-877-852-0641. TTY users, call 711.
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.
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.