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)

2025 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
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

Plan options and costs
Benefits	UnitedHealthcare® Group Medicare Advantage (PPO)
UnitedHealthcare® Group Medicare Advantage (PPO)
Annual medical deductible	$0
Annual medical deductible
$0
Annual medical out-of-pocket maximum	$2, 500
Annual medical out-of-pocket maximum
$2, 500
Office and clinic visits	$5 copay for primary care $25 copay for specialist visit
Office and clinic visits
$5 copay for primary care $25 copay for specialist visit
Hospital services (inpatient)	$250 copay per stay
Hospital services (inpatient)
$250 copay per stay
Hospital services (outpatient)	$100 copay
Hospital services (outpatient)
$100 copay
Prescription drug coverage	Retail Tier 1: $15 copay Tier 2: $35 copay Tier 3: $70 copay Tier 4: $70 copay Mail Order Tier 1: $30 copay Tier 2: $70 copay Tier 3: $140 copay Tier 4: $140 copay
Prescription drug coverage
Retail Tier 1: $15 copay Tier 2: $35 copay Tier 3: $70 copay Tier 4: $70 copay Mail Order Tier 1: $30 copay Tier 2: $70 copay Tier 3: $140 copay Tier 4: $140 copay

Important 2025 changes explained

For 2025, all stand-alone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage will be impacted by changes made by the federal government. This video provides an overview of those changes.

Learn more

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.