AARP Medicare Advantage Mosaic Choice (PPO)

Monthly Premium: $0

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AARP Medicare Advantage Mosaic Choice (PPO)

Monthly Premium
^$0
$0

Primary Care Provider
Tier 1: ^$0 copay
Tier 2: ^$25 copay
Tier 1: $0 copay
Tier 2: $25 copay

Out-of-Pocket Maximum
^$6,900
$6,900

Estimated Annual Drug Cost

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Costs	In-network - What you'll pay	Out-of-network - What you'll pay
Monthly Premium Monthly Premium ¹ $0$0	$0
Annual Medical Deductible Annual Medical Deductible $0$1,000	$0	$1,000
Out-of-Pocket Maximum Out-of-Pocket Maximum $6,900$10,000 combined in- and-out-of-network	$6,900	$10,000 combined in- and-out-of-network

Costs	In-network - what you'll pay	Out-of-network - what you'll pay
Primary Care Provider Primary Care Provider Tier 1: $0 copay Tier 2: $25 copay50% of the cost	Tier 1: $0 copay Tier 2: $25 copay	50% of the cost
Specialist Specialist Tier 1: $25 copay Tier 2: $50 copay50% of the cost	Tier 1: $25 copay Tier 2: $50 copay	50% of the cost
Referral Required Referral Required NoNo	No	No
National Network National Network NoNo	No

Costs	What you'll pay
Annual Prescription Deductible $0 for Tiers 1-2 $250 for Tiers 3-5	$0 for Tiers 1-2 $250 for Tiers 3-5
Tier 1: Preferred Generic Drugs Standard Network Pharmacy Cost Sharing (30 days) $0 copay Preferred Mail Order Pharmacy (100 days) $0 copay Standard Mail Order Pharmacy (100 days) $0 copay	Standard Network Pharmacy Cost Sharing (30 days) $0 copay Preferred Mail Order Pharmacy (100 days) $0 copay Standard Mail Order Pharmacy (100 days) $0 copay
Tier 2: Generic Drugs Standard Network Pharmacy Cost Sharing (30 days) $12 copay Preferred Mail Order Pharmacy (100 days) $0 copay Standard Mail Order Pharmacy (100 days) $36 copay	Standard Network Pharmacy Cost Sharing (30 days) $12 copay Preferred Mail Order Pharmacy (100 days) $0 copay Standard Mail Order Pharmacy (100 days) $36 copay
Tier 3: Preferred Brand Drugs Standard Network Pharmacy Cost Sharing (30 days) $47 copay Preferred Mail Order Pharmacy (100 days) $131 copay Standard Mail Order Pharmacy (100 days) $141 copay	Standard Network Pharmacy Cost Sharing (30 days) $47 copay Preferred Mail Order Pharmacy (100 days) $131 copay Standard Mail Order Pharmacy (100 days) $141 copay
Tier 3: Select Insulin Drugs Standard Network Pharmacy Cost Sharing (30 days) $35 copay Preferred Mail Order Pharmacy (100 days) $95 copay Standard Mail Order Pharmacy (100 days) $105 copay	Standard Network Pharmacy Cost Sharing (30 days) $35 copay Preferred Mail Order Pharmacy (100 days) $95 copay Standard Mail Order Pharmacy (100 days) $105 copay
Tier 4: Non-Preferred Drugs Standard Network Pharmacy Cost Sharing (30 days) $100 copay Preferred Mail Order Pharmacy (100 days) $290 copay Standard Mail Order Pharmacy (100 days) $300 copay	Standard Network Pharmacy Cost Sharing (30 days) $100 copay Preferred Mail Order Pharmacy (100 days) $290 copay Standard Mail Order Pharmacy (100 days) $300 copay
Tier 5: Specialty Tier Drugs Standard Network Pharmacy Cost Sharing (30 days) 29% of the cost	Standard Network Pharmacy Cost Sharing (30 days) 29% of the cost
Coverage Gap Stage ⁷ During the Coverage Gap Stage, you (or others on your behalf) will pay no more than 25% of the price for generic drugs or 25% of the price (plus the dispensing fee) for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $7,400 in year-to-date out-of-pocket costs. You may pay less if your plan has additional coverage in the gap. Always use your Medicare Advantage member ID card during the coverage gap to get the plan's discounted drug rates. The money you spend using your card counts toward your out-of-pocket costs.	During the Coverage Gap Stage, you (or others on your behalf) will pay no more than 25% of the price for generic drugs or 25% of the price (plus the dispensing fee) for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $7,400 in year-to-date out-of-pocket costs. You may pay less if your plan has additional coverage in the gap. Always use your Medicare Advantage member ID card during the coverage gap to get the plan's discounted drug rates. The money you spend using your card counts toward your out-of-pocket costs.
Catastrophic Coverage Stage After your total out-of-pocket costs reach $7,400, you will pay the greater of $4.15 copay for generic (including brand drugs treated as generic), and $10.35 copay for all other drugs, or 5% coinsurance.	After your total out-of-pocket costs reach $7,400, you will pay the greater of $4.15 copay for generic (including brand drugs treated as generic), and $10.35 copay for all other drugs, or 5% coinsurance.
Preferred Mail Home Delivery through OptumRx ⁸ $0 copay for at least 3-month supply of Tier 1 medications with Preferred Mail Home Delivery from OptumRx.	$0 copay for at least 3-month supply of Tier 1 medications with Preferred Mail Home Delivery from OptumRx.

Costs	What you'll pay
Dental $0 copay for covered network preventive services including oral exams, routine cleanings, X-rays, and fluoride. You will have access to Medicare Advantage's largest dental network, or you can choose any dentist that accepts Medicare. Seeing a network dentist may save you money. Click here for details(PDF)	$0 copay for covered network preventive services including oral exams, routine cleanings, X-rays, and fluoride. You will have access to Medicare Advantage's largest dental network, or you can choose any dentist that accepts Medicare. Seeing a network dentist may save you money. Click here for details(PDF)

Optional Services (Riders)

Dental Platinum: add $52 to your monthly premium.

$1,500 per year for covered dental services through the Platinum Dental Rider.
No deductible.
$0 copay for in-network exams, x-rays, cleanings, fluoride, fillings, crowns, bridges, root canals, extractions, dentures, implants, and all other covered comprehensive services.
Access to the largest Medicare Advantage dental network. Out-of-network coverage is available. If you choose to see an out-of-network dentist you might be billed more, even for services listed as $0 copay.

Platinum Dental (PDF)

Plan Dental Platinum (EspaÃ±ol) (PDF)

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Medical Benefit Information

See this plan's benefits, costs and copays. For full plan details, see the Evidence of Coverage or Summary of Benefits under the Plan Documents section.

Costs	In-network - What you'll pay	Out-of-network - What you'll pay
Ambulatory Surgical Center Ambulatory Surgical Center ² $0 copay - $295 copay50% of the cost	$0 copay - $295 copay	50% of the cost
Diabetes Monitoring Supplies Diabetes Monitoring Supplies ² $0 copay for covered brands50% of the cost	$0 copay for covered brands	50% of the cost
Diagnostic Radiology Services (such as MRIs/CT scans, etc.) Diagnostic Radiology Services (such as MRIs/CT scans, etc.) $0 copay - $60 copay50% of the cost	$0 copay - $60 copay	50% of the cost
Diagnostic Tests and Procedures, non-radiological (such as EKG/ECG tests, etc.) Diagnostic Tests and Procedures, non-radiological (such as EKG/ECG tests, etc.) $25 copay50% of the cost	$25 copay	50% of the cost
Emergency Care Emergency Care $90 copay per visit ($0 copay when outside of the United States)$90 copay per visit ($0 copay when outside of the United States)	$90 copay per visit ($0 copay when outside of the United States)
Ambulance Services Ambulance Services $250 copay for ground or air$250 copay for ground or air	$250 copay for ground or air	$250 copay for ground or air
Home Health Care Home Health Care $0 copay50% of the cost	$0 copay	50% of the cost
Inpatient Hospital Care Inpatient Hospital Care $360 copay per day: Days 1-5; $0 copay per day for unlimited days after that50% per stay	$360 copay per day: Days 1-5; $0 copay per day for unlimited days after that	50% per stay
Lab Services Lab Services $0 copay$0 copay	$0 copay	$0 copay
Mental Health (outpatient) Mental Health (outpatient) Group: $15 copay Individual: $25 copayGroup: $30 copay Individual: $40 copay	Group: $15 copay Individual: $25 copay	Group: $30 copay Individual: $40 copay
Opioid Treatment Services Opioid Treatment Services $0 copay$0 copay	$0 copay	$0 copay
Outpatient Hospital Services (includes observation services) Outpatient Hospital Services (includes observation services) ² $0 copay - $295 copay50% of the cost	$0 copay - $295 copay	50% of the cost
Outpatient X-rays Outpatient X-rays $25 copay$30 copay	$25 copay	$30 copay
Preventive Services (such as covered screenings, vaccinations, etc.) Preventive Services (such as covered screenings, vaccinations, etc.) ² $0 copay for covered services$0 copay - 50% of the cost (depending on the service)	$0 copay for covered services	$0 copay - 50% of the cost (depending on the service)
Skilled Nursing Facility Skilled Nursing Facility $0 copay per day: Days 1-20 $196 copay per day: Days 21-56 $0 copay per day: Days 57-10050% of the cost	$0 copay per day: Days 1-20 $196 copay per day: Days 21-56 $0 copay per day: Days 57-100	50% of the cost
Urgent Care Urgent Care $40 copay per visit ($0 copay when outside of the United States)$40 copay per visit ($0 copay when outside of the United States)	$40 copay per visit ($0 copay when outside of the United States)
UnitedHealth PassportÂ® Travel Benefit (PDF) Covered in the UnitedHealth Passport service area; see PDF for more detail	Covered in the UnitedHealth Passport service area; see PDF for more detail

Extra Benefits and Programs

See more of the benefits and programs offered by this plan that are not provided under Original Medicare. For full plan details, see the Evidence of Coverage or Summary of Benefits under the Plan Documents section.

Costs	In-network - What you'll pay	Out-of-network - What you'll pay
Eye Exam Eye Exam ³ $0 copay; 1 per year50% of the cost; combined visits In and Out of Network	$0 copay; 1 per year	50% of the cost; combined visits In and Out of Network
Routine Eyewear Routine Eyewear ³ $0 copay Plan pays up to $150 every year for frames or contact lenses. Standard single, bifocal, trifocal, or progressive lenses are covered in full. Home delivered eyewear available nationwide only through UnitedHealthcare Vision (select products only).$0 copay Plan pays up to $150 every year for frames or contact lenses. Standard single, bifocal, trifocal, or progressive lenses are covered in full. Home delivered eyewear available nationwide only through UnitedHealthcare Vision (select products only).	$0 copay Plan pays up to $150 every year for frames or contact lenses. Standard single, bifocal, trifocal, or progressive lenses are covered in full. Home delivered eyewear available nationwide only through UnitedHealthcare Vision (select products only).
Hearing Exam Hearing Exam ³ $0 copay; 1 per year50% of the cost; combined visits In and Out of Network	$0 copay; 1 per year	50% of the cost; combined visits In and Out of Network
Hearing Aids Hearing Aids ³ $175 copay - $1,225 copay for each hearing aid through UnitedHealthcare Hearing, up to 2 hearing aids every year. Includes hearing aids delivered directly to you with virtual follow-up care (select models).$175 copay - $1,225 copay for each hearing aid through UnitedHealthcare Hearing, up to 2 hearing aids every year. Includes hearing aids delivered directly to you with virtual follow-up care (select models).	$175 copay - $1,225 copay for each hearing aid through UnitedHealthcare Hearing, up to 2 hearing aids every year. Includes hearing aids delivered directly to you with virtual follow-up care (select models).
Fitness Program through Renew ActiveÂ® Fitness Program through Renew ActiveÂ® $0 copay for Renew Active, which includes a free gym membership, plus online fitness classes, brain health challenges and 1 FitbitÂ® device.$0 copay for Renew Active, which includes a free gym membership, plus online fitness classes, brain health challenges and 1 FitbitÂ® device.	$0 copay for Renew Active, which includes a free gym membership, plus online fitness classes, brain health challenges and 1 FitbitÂ® device.
Acupuncture Acupuncture $5 copay; 12 acupuncture visits per year$10 copay; combined visits In and Out of Network	$5 copay; 12 acupuncture visits per year	$10 copay; combined visits In and Out of Network
Annual Routine Physical Annual Routine Physical ⁴ $0 copay; 1 per year50% of the cost; combined visits In and Out of Network	$0 copay; 1 per year	50% of the cost; combined visits In and Out of Network
Foot Care - Routine Foot Care - Routine ³ $25 copay; 6 visits per year50% of the cost; combined visits In and Out of Network	$25 copay; 6 visits per year	50% of the cost; combined visits In and Out of Network
Meal Benefit Meal Benefit $0 copay for 28 home-delivered meals immediately after an inpatient hospitalization or skilled nursing facility (SNF) stay.$0 copay for 28 home-delivered meals immediately after an inpatient hospitalization or skilled nursing facility (SNF) stay.	$0 copay for 28 home-delivered meals immediately after an inpatient hospitalization or skilled nursing facility (SNF) stay.
Naturopathy Services Naturopathy Services No CoverageNo Coverage	No Coverage	No Coverage
NurseLine NurseLine ³ Speak with a Registered Nurse (RN) 24 hours a day, 7 days a week.Speak with a Registered Nurse (RN) 24 hours a day, 7 days a week.	Speak with a Registered Nurse (RN) 24 hours a day, 7 days a week.
Over-the-Counter (OTC) Products Card Over-the-Counter (OTC) Products Card ⁴ $40 credit per quarter to buy covered OTC products.$40 credit per quarter to buy covered OTC products.	$40 credit per quarter to buy covered OTC products.
Virtual Medical Visits Virtual Medical Visits $0 copay; Speak to network telehealth providers using your computer or mobile device.$0 copay; Speak to network telehealth providers using your computer or mobile device.	$0 copay; Speak to network telehealth providers using your computer or mobile device.
Virtual Mental Health Visits Virtual Mental Health Visits $0 copay; Speak to network telehealth providers using your computer or mobile device.$0 copay; Speak to network telehealth providers using your computer or mobile device.	$0 copay; Speak to network telehealth providers using your computer or mobile device.

Foonotesâ¯

¹ The amount shown does not include the Part B premium you already pay to the government. Your plan costs, including premiums and drug costs, may be different if you get Extra Help from the government or if you have Medicaid. For more information, see "Can I Get Help with my Medicare Prescription Drug Costs?."

Benefits, premium and/or copayments/coinsurance may change on January 1 of each year.â¯

² Amounts may vary depending on the level of care provided or the type of health care services you receive.â¯

³ Benefits, features and/or devices may vary by plan/area. Limitations and exclusions apply. See theâ¯Summary of Benefits (PDF) in the Plan Documents sectionâ¯for details.â¯

⁴ Benefits, features and/or devices may vary by plan/area. Limitations and exclusions apply. Seeâ¯the Evidence of Coverage (PDF) in the Plan Documents sectionâ¯for details.â¯

⁵ This document is the Annual Notice of Changes for this plan. If you are a current plan member and have been switched to a different plan, this document may not apply to you. If you have any questions, please call Customer Service at the number on your member ID card.â¯

⁷ Coverage Gap Stage:â¯

NOTE: Only applies to plans with prescription drug coverage.â¯

Amounts displayed do not include taxes or injection fees.â¯

During the Coverage Gap, amounts displayed for brand name drugs include a 70% manufacturer discount. However, this discount is based on pharmaceutical manufacturers' participation and may not apply to all brand drugs. You pay 25% of the total cost for brand name drugs, for any drug tier during the Coverage Gap.â¯

The 25% drug coinsurance within the Coverage Gap is based on an assessment that the drug is defined as a generic drug according to Part D rules.â¯

If your drug is not eligible for coverage under Medicare Part D, you will pay the full cost of the drug.â¯

⁸ Optum Mail Home Delivery:â¯

NOTE: Only applies to plans with prescription drug coverage.â¯

2023 Savings Benefitâ¯

Savings apply during the Initial Coverage period, which begins after the payment of your required deductible (if any) and ends when the total cost of your drugs (paid by UnitedHealthcare, you and others) reaches $4,660.

OptumRx is an affiliate of UnitedHealthcare Insurance Company. Optum Home Delivery is a service of OptumRx pharmacy. You are not required to use Optum Home Delivery to obtainâ¯at least a 3-month supply of your maintenance medication. If you have not used Optum Home Delivery, you must approve the first prescription order sent directly from your doctor to OptumRx before it can be filled. New prescriptions from the pharmacy should arrive within ten business days from the date the completed order is received, and refill orders should arrive in about seven business days. Contact OptumRx anytime at 1-877-266-4832 (TTY 711).â¯

$0 copays may be restricted to preferred home delivery prescriptions during the initial coverage phase and may not apply during the coverage or catastrophic stage. Benefits vary by plan/area. Limitations and exclusions apply.â¯â¯

Disclaimersâ¯

PPO Plans:â¯

Preferred Provider Organization (PPO) plans offer you the option to receive care from out-of-network providers; however, you will generally have a higher copay or higher coinsurance if you choose to go out-of-network. 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.â¯

POS Plans:

Point of Service (POS) plans offer you the option to receive care from out-of-network providers; however, you will generally have a higher copay or higher coinsurance if you choose to go out-of-network.â¯

Coverage Determinations and Appeals Process

Find important information about Medicare Advantage coverage determinations and appeals, quality assurance policies, grievances, drug conditions and limitations. View Medicare Advantage (Part C) coverage determinations and appeals process.â¯

Learn about prescription drug coverage determinations and appeals, prior authorization criteria, step therapy criteria and the 60-day formulary change notice. View prescription drug (Part D) coverage determinations and appeals process.â¯

View the UnitedHealthcare Prescription Drug Transition Process.â¯

Information for Plans with Prescription Drug Coverage

The list of covered drugs was last updated on 03/01/2023.â¯

NOTE: Prescription drugs that are not covered by the plan or that cannot be provided as part of standard Medicare prescription drug coverage are shown as "not covered".â¯

Copay or coinsurance amounts may change if you have a limited income.â¯

The drug costs displayed are estimates and may vary based on the specific quantity, strength and/or dosage of the medication and the pharmacy you use.â¯It may be important to look beyond your current needs at the value of having Medicare prescription drug insurance. Enrolling when you become eligible will help give you peace of mind, should your drug needs become more significant in the future. It may also help you avoid the Medicare late enrollment penalty.â¯

Drugs and prices may vary between pharmacies and are subject to change during the plan year. Prices are based on quantity filled at the pharmacy. Quantities may be limited by pharmacy based on their dispensing policy or by the plan based on Quantity Limit requirements; if prescription is in excess of a limit, copay amounts may be higher.â¯

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.â¯

All network pharmacies may not be listed in this directory. Inclusion of a pharmacy does not guarantee that the pharmacy is open, is at the same location as listed in this online directory or is included in the network. The pharmacy network may change at any time. You will receive notice when necessary. Pharmacies on this list are called ânetwork pharmaciesâ because UnitedHealthcare has made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under your plan only if they are filled at a network pharmacy or through our mail order pharmacy service. You are not required to continue using the same pharmacy to fill your prescriptions and may switch to any other network pharmacy. Prescriptions can be filled at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and your planâs formulary. Please contact UnitedHealthcare for details.â¯

UnitedHealthcare has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area.â¯

The pharmacy directory is current as of the first Sunday of each month.â¯

NOTE: If you are receiving Extra Help from Medicare, your copays may be lower or you may have no copays.â¯

Enrollment Disclaimer Information

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the planâs contract renewal with Medicare. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll. AARP encourages you to consider your needs when selecting products and does not make specific product or pharmacy recommendations for individuals. UnitedHealthcare contracts directly with Walgreens for this plan; AARP and its affiliates are not parties to that contractual relationship.â¯

Dental (Routine/Comprehensive): Benefits vary by plan/area. Limitations and exclusions apply. If your plan offers out-of-network dental coverage and you see an out-of-network dentist, you might be billed more. Network size varies by local market.

Fitbit: Choose one device from approved select models every 2 years. Devices may vary by plan/area. Limitations and exclusions apply. Fitbit, the Fitbit logo, and related marks and logos are trademarks of Google LLC and/or its affiliates.â¯

Flex Card: Benefits and features vary by plan/area. Limitations and exclusions apply.Flex benefit allowance expires at the end of the plan year.Flex benefit allowance must be used at dental, vision or hearing providers that accept Visa.

Hearing: Benefits, features, and/or devices vary by plan/area. Limitations and exclusions may apply. Other hearing exam providers are available in the UnitedHealthcare network. The plan only covers hearing aids from a UnitedHealthcare Hearing network provider.

Network: Network size varies by plan and market. Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.â¯

Over-the-Counter (OTC): Benefits and features vary by plan/area. Limitations and exclusions apply. Food, OTC and utility benefits have expiration timeframes. Call your plan or review your Evidence of Coverage (EOC) for more information.

PERS: Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply. You must have a working landline and/or cellular phone coverage to use PERS.â¯

Renew Active: Participation in the Renew Active^Â®program is voluntary. Consult your doctor prior to beginning an exercise program. Renew Active includes standard fitness membership and other offerings.

â¯

Fitness membership equipment, classes, personalized fitness plans, caregiver access and events may vary by location. Certain services, discounts, classes, events and online fitness offerings are provided by affiliates of UnitedHealthcare Insurance Company or other third parties not affiliated with UnitedHealthcare. Participation in these third-party services are subject to your acceptance of their respective terms and policies. UnitedHealthcare is not responsible for the services or information provided by third parties. The information provided through these services is for informational purposes only and is not a substitute for the advice of a doctor. Gym network may vary in local market.

Vision: Vision benefits vary by plan and are not available with all plans. Limitations and exclusions apply. Additional charges may apply for out-of-network items and services.

This information is not a complete description of benefits. Call us for more information.

This information is available for free in other languages. Please contact Customer Service for additional information.â¯

Esta informaciÃ³n estÃ¡ disponible sin costo en otros idiomas. Para obtener mÃ¡s informaciÃ³n comunÃquese con nuestro Servicio al Cliente.â¯

Every year, Medicare evaluates plans based on a 5-star rating system.

General Plan Information Enrollment Form (PDF) (Updated 10/20/2022) Summary of Benefits (PDF) (Updated 09/22/2022) Evidence of Coverage (PDF)* (Updated 03/20/2023) Star Ratings (PDF) Annual Notice of Changes (ANOC) (PDF)⁵ (Updated 09/24/2022) UnitedHealth Passport Program (PDF) Benefit Highlights (Updated 09/29/2022)	Enrollment Form (PDF) (Updated 10/20/2022) Summary of Benefits (PDF) (Updated 09/22/2022) Evidence of Coverage (PDF)* (Updated 03/20/2023) Star Ratings (PDF) Annual Notice of Changes (ANOC) (PDF)⁵ (Updated 09/24/2022) UnitedHealth Passport Program (PDF) Benefit Highlights (Updated 09/29/2022)
Medical Providers Provider Directory (PDF) (Updated 02/24/2023) Vendor Information Sheet (PDF)	Provider Directory (PDF) (Updated 02/24/2023) Vendor Information Sheet (PDF)
Prescription Drug Coverage Comprehensive Formulary (PDF) (Updated 02/22/2023) Prior Authorization Criteria (PDF) Step Therapy Criteria (PDF) Formulary Additions (PDF) Formulary Deletions (PDF) Alternative Drugs List (PDF)	Comprehensive Formulary (PDF) (Updated 02/22/2023) Prior Authorization Criteria (PDF) Step Therapy Criteria (PDF) Formulary Additions (PDF) Formulary Deletions (PDF) Alternative Drugs List (PDF)
Pharmacy Directory Online Pharmacy Directory	Online Pharmacy Directory

General Plan Information Formulario de InscripciÃ³n (PDF) (Updated 10/18/2022) Resumen de Beneficios (PDF) (Updated 09/27/2022) Comprobante de Cobertura (PDF)* (Updated 03/20/2023) ClasificaciÃ³n de la Calidad del Plan (PDF) Aviso Annual de Cambios (PDF)⁵ (Updated 09/28/2022) Programa UnitedHealth Passport (en formato PDF) Beneficios Importantes (Updated 09/29/2022) è¨»åè¡¨æ ¼ (PDF) (Updated 10/20/2022) ç¦å©æ¦è¦½ (PDF) (Updated 10/12/2022) æ¿ä¿èæ¸ (PDF)* (Updated 02/01/2023) æç´è©å® (PDF) å¹´åº¦è®æ´éç¥ (PDF)⁵ (Updated 10/15/2022) è¯åå¥åº·è·ç§(UnitedHealth Passport) è¨å(PDFæª) ç¦å©æè¦ (PDF) (Updated 10/10/2022)	Formulario de InscripciÃ³n (PDF) (Updated 10/18/2022) Resumen de Beneficios (PDF) (Updated 09/27/2022) Comprobante de Cobertura (PDF)* (Updated 03/20/2023) ClasificaciÃ³n de la Calidad del Plan (PDF) Aviso Annual de Cambios (PDF)⁵ (Updated 09/28/2022) Programa UnitedHealth Passport (en formato PDF) Beneficios Importantes (Updated 09/29/2022) è¨»åè¡¨æ ¼ (PDF) (Updated 10/20/2022) ç¦å©æ¦è¦½ (PDF) (Updated 10/12/2022) æ¿ä¿èæ¸ (PDF)* (Updated 02/01/2023) æç´è©å® (PDF) å¹´åº¦è®æ´éç¥ (PDF)⁵ (Updated 10/15/2022) è¯åå¥åº·è·ç§(UnitedHealth Passport) è¨å(PDFæª) ç¦å©æè¦ (PDF) (Updated 10/10/2022)
Medical Providers Directorio de Proveedores (PDF) (Updated 02/24/2023) InformaciÃ³n sobre proveedores - Spanish (PDF) é«çåå (PDF) (Updated 02/24/2023) ä¾æåè³è¨è¡¨ - Chinese (PDF)	Directorio de Proveedores (PDF) (Updated 02/24/2023) InformaciÃ³n sobre proveedores - Spanish (PDF) é«çåå (PDF) (Updated 02/24/2023) ä¾æåè³è¨è¡¨ - Chinese (PDF)
Prescription Drug Coverage Formulario Completo (PDF) (Updated 02/22/2023) Lista de Medicamentos Alternativos - Spanish (PDF) ç¶åèæ¹è¥ä¸è¦½è¡¨(PDF) (Updated 02/24/2023) æ¿ä»£è¥ç©æ¸å® (PDF)	Formulario Completo (PDF) (Updated 02/22/2023) Lista de Medicamentos Alternativos - Spanish (PDF) ç¶åèæ¹è¥ä¸è¦½è¡¨(PDF) (Updated 02/24/2023) æ¿ä»£è¥ç©æ¸å® (PDF)
Pharmacy Directory Directorio de Farmacias en Internet ç¶²ç«æ¥è©¢ç¶²ä¸è¥æ¿åå	Directorio de Farmacias en Internet ç¶²ç«æ¥è©¢ç¶²ä¸è¥æ¿åå

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AARP Medicare Advantage Mosaic Choice (PPO)

General Plan Costs

Doctor Visits

Prescription Drug Benefits

Dental Coverage

Optional Services (Riders)

Medical Benefit Information

Extra Benefits and Programs

Plan Documents

Footnotes & Disclaimers

Foonotesâ¯

Disclaimersâ¯

PPO Plans:â¯

POS Plans:

Coverage Determinations and Appeals Process

Information for Plans with Prescription Drug Coverage

Enrollment Disclaimer Information

We're here to help

Foonotesâ¯

Disclaimersâ¯

PPO Plans:â¯