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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.
2025 materials
Coming soon
UnitedHealthcare® Group Medicare Advantage (PPO)
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Plan Guide - Coming soon
UnitedHealthcare® Senior Supplement Plan
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Plan guide -Coming soon
UnitedHealthcare® MedicareRx for Groups (PDP)
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Plan guide - Coming soon
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 |
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 |
*Medicare Part B deductible |
| Annual medical deductible | ||
|
None |
*Medicare Part B deductible |
|
| Annual out-of-pocket maximum |
$2000 |
*$2,000 (plus Medicare Part B deductible); excludes routine vision and foreign travel emergency copays or coinsurance amounts |
| Annual out-of-pocket maximum | ||
|
$2000 |
*$2,000 (plus Medicare Part B deductible); excludes routine vision and foreign travel emergency copays or coinsurance amounts |
|
| 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 aids: $1,500 maximum benefit (in-network only); once every 3 years; includes digital hearing aids |
Routine Hearing Exam (every year): $0 Hearing aids: $5,000 maximum benefit; once every 2 years; includes digital hearing aids |
| Hearing | ||
|
Routine Hearing Exam (every year): $0 Hearing aids: $1,500 maximum benefit (in-network only); once every 3 years; includes digital hearing aids |
Routine Hearing Exam (every year): $0 Hearing aids: $5,000 maximum benefit; once every 2 years; includes digital hearing aids |
|
| 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 |
|
*2024 CMS Data
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.