Coverage and benefits

UC Medicare Choice = UnitedHealthcare Group Medicare Advantage PPO

It’s important to know that your providers may refer to the UC Medicare Choice Plan name as UnitedHealthcare Group Medicare Advantage PPO Plan. You are still entitled to all the custom benefits of UC Medicare Choice even though your provider’s billing system may refer to UC Medicare Choice as UnitedHealthcare Group Medicare Advantage PPO. If your provider asks you for the name of your plan, you should state that you have the UnitedHealthcare Group Medicare Advantage PPO plan.

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.

 

UC Medicare Choice (PPO)

2025 materials

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.

Benefits and costs

Benefits and costs
Benefit UC Medicare Choice (PPO)
Annual medical deductible $0 
Medical annual out-of-pocket maximum $1,500
Office and clinic visits $30 copay for primary care
$30 copay for specialist visit
Virtual office visit cost share $0 when using Doctor on Demand or AmWell
$30 copay for all other virtual visits, including behavioral health
Hospital services (inpatient) $250 copay
Mental health inpatient visit $250 copay per stay
Mental health outpatient group therapy visit $30 copay
Mental health outpatient individual therapy visit $30 copay
Hospital services (outpatient) $100 copay for surgery
$0 copay for all other procedures
Prescription drug coverage

Retail 30 day supply

Tier 1: $10 copay
Tier 2: $30 copay
Tier 3: $45 copay
Tier 4: $30 copay

Home Delivery 90-day supply

Tier 1: $20 copay
Tier 2: $60 copay
Tier 3: $90 copay
Tier 4: Not covered

Catastrophic Coverage:· During this payment stage, the plan pays the full cost for your covered drugs. You pay nothing.

*Including University of California Medical Center pharmacies

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.