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

Plan Materials - Coming soon

Part D Plan materials

Plan Materials - Coming soon

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).

Plan options and costs
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
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

Plan options and costs
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 $50 for Tier 3, Tier 4 and Tier 5	$0 for Tier 1 and Tier 2 $395 for Tier 3, Tier 4 and Tier 5
Annual prescription (Part D ) deductible
$0 for Tier 1 and Tier 2 $50 for Tier 3, Tier 4 and Tier 5	$0 for Tier 1 and Tier 2 $395 for Tier 3, Tier 4 and Tier 5

Understanding the 2026 IBM subsidy (pdf)

Understanding the IBM 2025 subsidy (pdf)

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.