Coverage and Benefits

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

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.

UnitedHealthcare® Group Medicare Advantage (PPO) - MAPD

2024 materials

Enhanced and Essential plan materials

Evidence of Coverage Documents

While you do have a choice, the Enhanced Plan may be the best option for most participants, based on its low copays and out of pocket maximum.

Plan options and costs

Plan options and costs
Benefits and Costs	UnitedHealthcare Group Medicare Advantage (PPO) – Enhanced Plan	UnitedHealthcare Group Medicare Advantage (PPO) – Essential Plan
UnitedHealthcare Group Medicare Advantage (PPO) – Enhanced Plan	UnitedHealthcare Group Medicare Advantage (PPO) – Essential 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
Prescription drug coverage	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 30% coinsurance Mail Order: $0 copay $37.50 copay $117.50 copay $250 copay 30% coinsurance
Prescription drug coverage
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 30% coinsurance Mail Order: $0 copay $37.50 copay $117.50 copay $250 copay 30% coinsurance
Annual prescription (Part D ) deductible	$0 for Tier 1 and Tier 2 $50 for Tier 3, Tier 4 and Tier 5 Estimate Drug Cost	$0 for Tier 1 and Tier 2 $395 for Tier 3, Tier 4 and Tier 5 Estimate Drug Cost
Annual prescription (Part D ) deductible
$0 for Tier 1 and Tier 2 $50 for Tier 3, Tier 4 and Tier 5 Estimate Drug Cost	$0 for Tier 1 and Tier 2 $395 for Tier 3, Tier 4 and Tier 5 Estimate Drug Cost

Understanding the IBM subsidy (pdf)

For additional information on the IBM subsidy and how it applies to with these new 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 member ID card.

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.