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.

 

2025 materials

UnitedHealthcare® Group Medicare Advantage (PPO)

UnitedHealthcare® Senior Supplement Plan

UnitedHealthcare® MedicareRx for Groups (PDP)

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.

2025 Benefits and costs

Plan options and costs
Benefit

UHC Group Medicare Advantage with Prescription Drug Coverage (PPO)

Senior Supplement with Vision and Hearing, Plus Prescription Drug Plan

UHC Group Medicare Advantage with Prescription Drug Coverage (PPO)

Senior Supplement with Vision and Hearing, Plus Prescription Drug Plan

Annual medical deductible

None

*Medicare Part B deductible

Annual medical deductible

None

*Medicare Part B deductible

Annual out-of-pocket maximum

$2000

*$2,000 (plus Medicare Part B deductible); excludes routine vision and foreign travel emergency copays or coinsurance amounts

Annual out-of-pocket maximum

$2000

*$2,000 (plus Medicare Part B deductible); excludes routine vision and foreign travel emergency copays or coinsurance amounts

Office and clinic visits

$10 copay

$10 copay

Office and clinic visits

$10 copay

$10 copay

Hospital services (inpatient)

$200 copay per admit

$250 copay per admit

Hospital services (inpatient)

$200 copay per admit

$250 copay per admit

Hospital services (outpatient)

$10 copay

$0 Non Surgery copay

$100 Surgical

Hospital services (outpatient)

$10 copay

$0 Non Surgery copay

$100 Surgical

Vision

Routine Eye Exam for Refraction (every 12-months): $10 copay

Eyeglasses and Contact Lenses (every 24 months): $500 allowance

Routine Eye Exam for Refraction (every 12-months): $0 copay

Eyeglasses and Contact Lenses (every 24 months): $500 allowance

Vision

Routine Eye Exam for Refraction (every 12-months): $10 copay

Eyeglasses and Contact Lenses (every 24 months): $500 allowance

Routine Eye Exam for Refraction (every 12-months): $0 copay

Eyeglasses and Contact Lenses (every 24 months): $500 allowance

Hearing

Routine Hearing Exam (every year): $0

Hearing aids: $1,500 maximum

benefit (in-network only); once

every 3 years; includes digital hearing aids

Routine Hearing Exam (every year): $0

Hearing aids: $5,000 maximum benefit; once every 2 years; includes digital hearing aids

Hearing

Routine Hearing Exam (every year): $0

Hearing aids: $1,500 maximum

benefit (in-network only); once

every 3 years; includes digital hearing aids

Routine Hearing Exam (every year): $0

Hearing aids: $5,000 maximum benefit; once every 2 years; includes digital hearing aids

Prescription drug coverage

Retail  

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Mail Order

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

Retail  

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Mail Order

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Prescription drug coverage

Retail  

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Mail Order

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

Retail  

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Mail Order

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Rx Deductible

$200

$200

Rx Deductible

$200

$200

*2025 CMS Data

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.

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.