Coverage and benefits
Get a quick overview of your plan benefits and costs and find more detailed information about additional benefits and programs.
UnitedHealthcare® Group Medicare Advantage (PPO)
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)|
|Annual medical deductible||$0|
|Annual out-of-pocket maximum||$6,700|
|Office and clinic visits||$10 copay for primary care
$15 copay for specialist visit
$0 copay for Virtual Doctor Visit
|Behavioral health||$14 copay in office
$14 copay for Virtual Behavioral Health Visit
|Urgent care||$24 copay|
|Hospital services (inpatient)||$0 copay|
|Hospital services (outpatient)||$0 copay|
|Diabetic supplies and monitors||
In-network: $0 copay
For diabetes monitoring supplies, the plan covers the following brands of blood glucose monitors and test strips: <OneTouch® Ultra® 2, OneTouch® Verio™, OneTouch® UltraMini™, ACCU-CHEK® Aviva, ACCU-CHEK® Compact, ACCU-CHEK® SmartView>. Other brands are not covered by our plan.
If you use a brand of supplies that is not covered by our plan, you should speak with your doctor to get a new prescription for a covered brand.
|Prescription drug coverage||Tier 1 Generic – up to 30-day supply: $3 copay
Tier 2 Preferred Brand – up to 30-day supply: $23 copay
Tier 3 Non-Preferred Brand – up to 30-day supply: $53 copay
Tier 4 Specialty Tier – up to 30-day supply: $53 copay
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.