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

National PPO plan overview

  • A national plan covering all eligible beneficiaries regardless of where they reside in the U.S., D.C. and 5 U.S. territories
  • Visit doctors, specialists and hospitals in or out of our network for the same cost share as long as the provider participates in Medicare and accepts the plan
  • Coverage for visiting doctors, clinics and hospitals
  • Routine podiatry, chiropractic, acupuncture, vision, hearing and nutritional therapy coverage
  • Routine eyewear and hearing aid allowances
  • No referral needed to see a specialist

Benefits and costs

Benefits and costs
Benefit UnitedHealthcare Group Medicare Advantage (PPO)
Annual medical deductible $0
Annual out-of-pocket maximum $3,000
Office and clinic visits $20 copay for primary care office visit
$35 copay for specialist office visit
Preventative services $0 copay for Annual Routine Physical and Medicare-covered preventive services
Hospital services (inpatient) $100 copay per admit
Hospital services (outpatient) $0 copay 
Emergency care $50 copay (includes worldwide coverage)
Urgent care $35 copay (includes worldwide coverage)
Prescription drug copays by tier

Retail 30-day supply

Tier 1 – Generic: $7 Preferred Retail Pharmacy: Walgreens
Tier 1 – Generic: $12 Non-preferred Retail Pharmacies
Tier 2 – Preferred Brand: $19 Preferred Retail Pharmacy: Walgreens
Tier 2 – Preferred Brand: $24 Non-preferred Retail Pharmacies
Tier 3 – Non-preferred Brand: $24 copay
Tier 4 – Specialty: 5% coinsurance

Mail order 90-day supply

Tier 1 – Generic: $24 copay
Tier 2 – Preferred Brand: $48 copay
Tier 3 – Non-preferred Brand: $48 copay
Tier 4 – Specialty: 5% coinsurance 

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.

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, including the cost sharing that applies to out-of-network services.