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)

2024 materials

MAPD plan

MA plan

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 information about these preventive services, please call the Customer Service number 1-877-298-2341, 8 a.m. – 8 p.m., local time, Monday - Friday. TTY users, call 711 on your member ID card.

Benefits and costs

Plan options and costs
Benefit and costs	UnitedHealthcare Group Medicare Advantage (PPO) - MAPD
UnitedHealthcare Group Medicare Advantage (PPO) - MAPD
Annual medical deductible	$226
Annual medical deductible
$226
Annual out-of-pocket mazimum	$8300
Annual out-of-pocket mazimum
$8300
Office visits	$13 Office $18 Specialist
Office visits
$13 Office $18 Specialist
Hospital services (inpatient)	$200 per day: Day 1 copay $25 per day: Days 2 - 5 copay $0 per day: Days 6 copay
Hospital services (inpatient)
$200 per day: Day 1 copay $25 per day: Days 2 - 5 copay $0 per day: Days 6 copay
Hospital services (outpatient)	$0 copay
Hospital services (outpatient)
$0 copay
Prescription drug coverage	Retail Tier 1: $6 copay Tier 2: $40 copay Tier 3: $60 copay Tier 4: $60 (limited to 30 day supply) Rx Out of pocket: $8000 Rx Deductible: $0
Prescription drug coverage
Retail Tier 1: $6 copay Tier 2: $40 copay Tier 3: $60 copay Tier 4: $60 (limited to 30 day supply) Rx Out of pocket: $8000 Rx Deductible: $0

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.