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Coverage and benefits
Get a quick overview of your plan benefits and costs and find ore detailed information about additional coverage and benefit services.
UnitedHealthcare® Group Medicare Advantage (PPO)
2021 materials
Standard plan
Standard plan
Preventative services
The following preventitive services are covered under your plan for a $0 copay when you visit your primary care provider:
- Screening and counseling to reduce alcohol misuse
- Screening for depression in adults
- Screening for Sexually Transmitted Infections (STIs) and high intensity behaviorl counseling to prevent STIs
- Intensive behavioral therapy to reduce cardiovascular disease risk
- Screening and counseling for obesity
For more information about these preventive services, please call the Customer Service number on the back of your plan ID card.
Benefits and costs
| Benefit | Cost for UnitedHealthcare® Group Medicare Advantage (HMO) | Cost for UnitedHealthcare® Group Medicare Advantage (PPO) |
|---|---|---|
| Annual medical deductible | None | $150 deductible on first inpatient hospitalization annually |
| Annual out-of-pocket maxium | $4,000 | $5,000 |
| Office and clinic visits | $15 copay for primary care $30 copay for specialst visit |
$15 copay for primary care $25 copay for specialist visit |
| Hospital services (inpatient) | $100 copay per admission | $0 after $150 annual inpatient deductible has been met |
| Hospital emergency services (out patient) | $50 copay for each Medicare-covered emergency room visit (waived if admitted) | $50 copay for each Medicare-covered emergency room visit (waived if admitted) |
| Prescription drug coverage | $15 copay for each Medicare-covered urgently needed care visit $10 copay generic Tier 1 $20 coapy generic Tier 1 mail-order |
$15 copay for each Medicare-covered urgently needed care visit $10 copay generic Tier 1 $20 coapy generic Tier 1 mail-order |
Benefits and costs
Out-of-network/non-contracted providers are under no obligation to treat UnitedHealtcare members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information.