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) and MedicareRx for Groups (PDP) - Enhanced

2026 materials

Enhanced

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.

UnitedHealthcare Group Medicare Advantage (PPO) and MedicareRx for Groups (PDP) Base

2026 materials

Base

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 UnitedHealthcare Group Medicare Advantage (PPO) and MedicareRx for Groups (PDP) - Base Plan UnitedHealthcare Group Medicare Advantage (PPO) and MedicareRx for Groups (PDP) – Enhanced Plan
Annual medical deductible $300 $0
Annual out-of-pocket maximum $3,400 $0
Office and clinic visits $10 copay for primary care visit
$20 copay for specialist visit		 $0 copay for primary care or specialist visit
Hospital services (inpatient) $200 copay per admission $0 per admission
Hospital services (outpatient) $100 copay for surgery and observation $0 copay
Emergency care $65 copay $0 copay
Urgent care $35 copay $0 copay
Medically-necessary services outside the United States $200,000 lifetime maximum $200,000 lifetime maximum
Prescription drug coverage

Retail:

Tier 1 – Generic: 20% coinsurance $7 minimum
Tier 2 – Preferred Brand: 20% coinsurance $15 minimum
Tier 3 – Non-Preferred Brand: 50% coinsurance $30 minimum
Tier 4 – Specialty: 25% coinsurance

Mail Order:(90-day supply)

Tier 1 – Generic: 20% coinsurance $15 minimum
Tier 2 – Preferred Brand: 20% coinsurance $30 minimum
Tier 3 – Non-Preferred Brand: 50% coinsurance $60 minimum
Tier 4 – Specialty: 25% coinsurance

After your total out-of -pocket costs reach $2,000 Once you’re in the Catastrophic Coverage stage, you won’t pay anything for your Medicare-covered Part D drugs for the rest of the plan year.
If your plan includes additional prescription drug coverage, you will continue to pay the cost-sharing
amounts from the Initial Coverage stage for those drugs. Please see your Additional Drug Coverage list for more information.

Retail:

Tier 1 – Generic: 20% coinsurance $7 minimum
Tier 2 – Preferred Brand: 20% coinsurance $15 minimum
Tier 3 – Non-Preferred Brand: 50% coinsurance $30 minimum
Tier 4 – Specialty: 25% coinsurance

Mail Order:(90-day supply)

Tier 1 – Generic: 20% coinsurance $15 minimum
Tier 2 – Preferred Brand: 20% coinsurance $30 minimum
Tier 3 – Non-Preferred Brand: 50% coinsurance $60 minimum
Tier 4 – Specialty: 25% coinsurance

After your total out-of -pocket costs reach $2,000 Once you’re in the Catastrophic Coverage stage, you won’t pay anything for your Medicare-covered Part D drugs for the rest of the plan year.
If your plan includes additional prescription drug coverage, you will continue to pay the cost-sharing
amounts from the Initial Coverage stage for those drugs. Please see your Additional Drug Coverage list for more information.
Rx deductible $520 $500

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.