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

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

Benefits and costs
Benefits and costs UnitedHealthcare Group Medicare Advantage (PPO)
Annual medical deductible $0
Annual out-of-pocket maximum $0
Office and clinic visits $0 copay
Hospital services (inpatient) $0 copay
Hospital services (outpatient) $0 copay
Prescription drug coverage


Tier 1: $10 copay
Tier 2: $30 copay
Tier 3: $40 copay
Tier 4: 12%

Mail Order

Tier 1: $15 copay
Tier 2: $45 copay
Tier 3: $60 copay
Tier 4: 12%

Optum Rx is an affiliate of UnitedHealthcare Insurance Company. You are not required to use
Optum Rx homedelivery for a 90-100 day supply of your maintenance medication.


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.