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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)
2024 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
| Benefit | UC Medicare Choice (PPO) |
|---|---|
| Annual medical deductible | $0 |
| Medical annual out-of-pocket maximum | $1,500 |
| Office and clinic visits | $20 copay for primary care $20 copay for specialist visit |
| Virtual office visit cost share | $0 when using Doctor on Demand or AmWell $20 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 | $20 copay |
| Mental health outpatient individual therapy visit | $20 copay |
| Hospital services (outpatient) | $100 copay for surgery $0 copay for all other procedures |
| Prescription drug annual out-of-pocket max | $2,000 |
| Prescription drug coverage | Retail 30 day supply Tier 1: $5 copay Home Delivery or Network Retail* 90-day supply Tier 1: $10 copay 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 |
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.