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Coverage and benefits
Get a quick overview of your plan benefits and costs and find ore detailed information about additional benefits and programs.
Benefits and costs
| Benefit | TRS-Care Medicare Advantage (PPO) | |
|---|---|---|
| Annual medical deductible | $400 | |
| Annual out-of-pocket maximum | $3,500 | |
| Office and clinic visits | Deductible does not apply $5 copay for primary care sick visit $0 copay for virtual doctor visit $0 copay for x-rays and diagnostic tests (if billed by a PCP) $0 copay for preventive services |
Must meet deductible $10 copay for specialist visit $0 copay for x-rays and diagnostic tests (if billed by specialist) |
| Behavioral health | $10 copay in office visit | |
| $10 copay for virtual behavioral health visit | ||
| Ambulance | 5% coinsurance | |
| Urgent care | $35 copay | |
| Emergency services | $65 copay | |
| Hospital services (inpatient) | $500 copay per admission | |
| Hospital services (outpatient) | $250 copay 5% coinsurance x-rays and diagnostic tests |
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| Diabetic supplies and monitors from a DME supplier | $0 copay for diabetes monitoring supplies. The plan covers the following brands of blood glucose monitors and test strips: 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. |
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| Durable medical equipment (DME) | DME – 5% coinsurance prosthetics – 5% coinsurance Medical Supplies from a DMS supplier or pharmacy - $10 copay |
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| Additional benefits | As a TRS-Care Medicare Advantage participant, you get all the benefits we have to offer, including some great extras, like a fitness program and a nurse healthline. View additional benefits. |
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| Vision | A routine eye exam once every 12 months with a $0 copay $70 allowance toward eyeglasses (frames and lenses), every 12 months. $105 allowance toward contact lenses instead of eyeglasses, every 12 months. Out-of-network providers may require you to pay upfront and submit a reimbursement claim to UHC. |
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*Are you currently a TRS-Care participant who will turn 65 in 2025? You will pay $0 deductible in the TRS-Care Medicare Advantage plan through December 31, 2025.
UnitedHealthcare® Group Medicare Advantage (PPO)
2025 materials
TRS-Care Medicare Advantage (PPO) – English
TRS-Care Medicare Advantage (PPO) – Spanish
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.
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.