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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.
Important Information about your Part D Vaccine and Insulin Coverage
What You Pay for Vaccines – Our plan covers most 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, no matter what cost-sharing tier it’s on. You may pay less depending on your plan coverage. Refer to your plan materials.
UnitedHealthcare® Group Medicare Advantage (PPO)
2023 materials
Plan I - 13651
Plan II - 13650
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.
Benefits and costs
| Benefit | UnitedHealthcare® Group Medicare Advantage (PPO) – Plan I - 13651 | UnitedHealthcare® Group Medicare Advantage (PPO) – Plan II - 13650 |
|---|---|---|
| Annual medical deductible | $0 | $0 |
| Annual medical out-of-pocket maximum | $2,500 | $2,800 |
| Office and clinic visits | $5 copay for primary care $25 copay for specialist visit |
$5 copay for primary care $25 copay for specialist visit |
| Hospital services (inpatient) | $250 copay per stay | $250 copay per stay |
| Hospital services (outpatient) | $100 copay | $100 copay |
| Prescription drug coverage | Retail Mail Order
|
Retail Mail Order
|
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.