Coverage and benefits

Get a quick overview of your plan benefits and costs and find more detailed information about additional benefits and programs.

UnitedHealthcare® Group Medicare Advantage (PPO)

2022 materials

Standard plan

Standard plan

Standard plan

Preventive services

The following preventive services are covered under your plan for a $0 copay when you visit your primary care physician:

  • Screening and counseling to reduce alcohol misuse
  • Screening for depression in adults
  • Screening for Sexually Transmitted Infections (STIs) and high intensity behavioral 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 your plan ID card.

Benefits and costs

Benefits and costs
Benefit UnitedHealthcare® Group Medicare Advantage (HMO) UnitedHealthcare® Group Medicare Advantage (PPO)
Annual medical deductible None $150 deductible on first inpatient hospitalization annually
Annual out-of-pocket maximum $4,000 $5,000
Office and clinic visits $15 copay for primary care
$30 copay for specialist 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 services (outpatient) $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

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.