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) plan with prescription drugs (MAPD)
General Status Members
2024 materials
Protected Status Members
2024 materials
Protected Status Members
General Status Members Benefits and costs
| Benefits |
General Status Members |
|---|---|
|
General Status Members |
|
| Annual medical deductible |
$0 |
| Annual medical deductible | |
|
$0 |
|
| Total out-of-pocket maximum |
$1,500 |
| Total out-of-pocket maximum | |
|
$1,500 |
|
| 24/7 Nurse Support |
$0 |
| 24/7 Nurse Support | |
|
$0 |
|
| Virtual Doctor Visit with AmWell, Doctors on Demand & Teladoc |
$0 |
| Virtual Doctor Visit with AmWell, Doctors on Demand & Teladoc | |
|
$0 |
|
| Primary Care Physician office visit |
$0 |
| Primary Care Physician office visit | |
|
$0 |
|
| Specialist office visit |
$10 |
| Specialist office visit | |
|
$10 |
|
| Urgent Care |
$15 |
| Urgent Care | |
|
$15 |
|
| Emergency Room |
$50 |
| Emergency Room | |
|
$50 |
|
| Hospital services (inpatient) |
$0 |
| Hospital services (inpatient) | |
|
$0 |
|
| Hospital services (outpatient) |
$0 |
| Hospital services (outpatient) | |
|
$0 |
|
| Prescription drug coverage |
Deductible: None Annual out-of-pocket maximum: $1,500 for Tier 2 only Retail 31-day supply; same as 90-day mail order Tier 1: $0 Tier 2: $33 Tier 3: $115 |
| Prescription drug coverage | |
|
Deductible: None Annual out-of-pocket maximum: $1,500 for Tier 2 only Retail 31-day supply; same as 90-day mail order Tier 1: $0 Tier 2: $33 Tier 3: $115 |
|
| Rx Maximum out of pocket |
$1500 ( Tier 2 drugs only) |
| Rx Maximum out of pocket | |
|
$1500 ( Tier 2 drugs only) |
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 costsharing that applies to out-of-network services.