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, no matter what cost-sharing tier it’s on. You may pay less depending on your plan coverage. Refer to your plan materials.

 

2024 materials

UnitedHealthcare® Group Medicare Advantage (PPO)

UnitedHealthcare® Senior Supplement Plan

UnitedHealthcare® MedicareRx for Groups (PDP)

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

Plan options and costs
Benefit

UHC Group Medicare Advantage with Prescription Drug Coverage (PPO)

Senior Supplement with Vision and Hearing, Plus Prescription Drug Plan

UHC Group Medicare Advantage with Prescription Drug Coverage (PPO)

Senior Supplement with Vision and Hearing, Plus Prescription Drug Plan

Annual medical deductible

None

*$240

Annual medical deductible

None

*$240

Annual out-of-pocket maximum

2000

*$2,240

Annual out-of-pocket maximum

2000

*$2,240

Office and clinic visits

$10 copay

$10 copay

Office and clinic visits

$10 copay

$10 copay

Hospital services (inpatient)

$200 copay per admit

$250 copay per admit

Hospital services (inpatient)

$200 copay per admit

$250 copay per admit

Hospital services (outpatient)

$10 copay

$0 Non Surgery copay

$100 Surgical

Hospital services (outpatient)

$10 copay

$0 Non Surgery copay

$100 Surgical

Vision

Routine Eye Exam for Refraction (every 12-months): $10 copay

Eyeglasses and Contact Lenses (every 24 months): $240 allowance

Routine Eye Exam for Refraction (every 12-months): $0 copay

Eyeglasses and Contact Lenses (every 24 months): $240 allowance

Vision

Routine Eye Exam for Refraction (every 12-months): $10 copay

Eyeglasses and Contact Lenses (every 24 months): $240 allowance

Routine Eye Exam for Refraction (every 12-months): $0 copay

Eyeglasses and Contact Lenses (every 24 months): $240 allowance

Hearing

Routine Hearing Exam (every year): $0

Hearing Aid Allowance: $1,500 every 3 years, combined for both ears

 Hearing aids purchased outside of UnitedHealthcare Hearing’s nationwide network are NOT covered.

Routine Hearing Exam (every year): $0

Hearing Aid Allowance: $5,000 every 2 years, combined for both ears 

 Hearing aids purchased outside of UnitedHealthcare Hearing’s nationwide network are NOT covered.

Hearing

Routine Hearing Exam (every year): $0

Hearing Aid Allowance: $1,500 every 3 years, combined for both ears

 Hearing aids purchased outside of UnitedHealthcare Hearing’s nationwide network are NOT covered.

Routine Hearing Exam (every year): $0

Hearing Aid Allowance: $5,000 every 2 years, combined for both ears 

 Hearing aids purchased outside of UnitedHealthcare Hearing’s nationwide network are NOT covered.

Prescription drug coverage

Retail  

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Mail Order

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

Retail  

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Mail Order

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Prescription drug coverage

Retail  

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Mail Order

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

Retail  

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Mail Order

Tier 1: 5%

Tier 2: 20%

Tier 3: 30%

Tier 4: 30%

 

Rx Deductible

$200

$200

Rx Deductible

$200

$200

Rx Maxium Out of Pocket

$3,500

$3,500

Rx Maxium Out of Pocket

$3,500

$3,500

*2024 CMS Data

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.