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

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

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.