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AARP Medicare Advantage Plan 1 (HMO-POS)
- Monthly Premium
- Primary Care Provider
- Out-of-Pocket Maximum
- Estimated Annual Drug Cost
General Plan Costs
See how much you'll pay for this plan including your premium, deductible and maximum out-of-pocket costs.
| Costs | What you'll pay | |
|---|---|---|
| Monthly Premium Monthly Premium 1 $0$0 | $0 | |
Annual Medical Deductible
Annual Medical Deductible
Annual Medical Deductible
The pre-set, fixed amount you must pay for health care costs before the insurance company or Medicare begins to pay. Please see your Evidence of Coverage for details.
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No deductible | |
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Out-of-Pocket Maximum
Out-of-Pocket Maximum
Out-of-Pocket Maximum
This is the highest amount of money you have to pay out of your pocket for cost sharing (copayments and coinsurance) charged for certain covered services during a calendar year. Not all copayments or coinsurance amounts you pay apply toward the annual out-of-pocket maximum. See the plan’s Evidence of Coverage for more information.
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$4,900 | |
Doctor Visits
Find out about this plan’s copays for primary care providers and specialists.
| Costs | What you'll pay | |
|---|---|---|
| Primary Care Provider Primary Care Provider $0 copay | $0 copay | |
| Specialist Specialist $25 copay | $25 copay | |
| Referral Required Referral Required No | No | |
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National Network
National Network
National Network
As a member of an eligible health plan, the UnitedHealthcare Medicare National Network allows you to have access to participating care providers across the United States at your in-network cost share, even when getting care outside of your home location. Networks vary by market and exclusions may apply.
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Yes | |
Prescription Drug Benefits
Learn about this plan's prescription drug coverage and costs. Enter your prescriptions to see what they'd cost with this plan.
| Costs | What you'll pay |
|---|---|
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Annual Prescription Deductible
Annual Prescription Deductible
If your plan has an annual deductible, you (or others on your behalf) will pay your drug costs up to the amount of this deductible before moving into the Initial Coverage stage.
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$0 |
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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 |
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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 |
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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 |
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Tier 3: Select Insulin Drugs
Tier 3: Select Insulin Drugs
For Chronic Special Needs plans: You will pay a maximum of $25 for each 1-month supply of Part D select insulin drug through all coverage stages. For all other plans: You will pay a maximum of $35 for each 1-month supply of Part D covered insulin drug through all coverage stages. 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 |
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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 |
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Tier 5: Specialty Tier Drugs
Standard Network Pharmacy Cost Sharing (30 days) 33% of the cost |
Standard Network Pharmacy Cost Sharing (30 days) 33% 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. |
Dental Coverage
Learn about this plan’s dental coverage options and costs.
| Costs | What you'll pay |
|---|---|
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Dental
$1,250 per year for covered dental services. $0 copay for covered network preventive services including oral exams, routine cleanings, X-rays and fluoride. $0 copay for covered network comprehensive services such as fillings, crowns, root canals, extractions, dentures and implants. 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. |
$1,250 per year for covered dental services. $0 copay for covered network preventive services including oral exams, routine cleanings, X-rays and fluoride. $0 copay for covered network comprehensive services such as fillings, crowns, root canals, extractions, dentures and implants. 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. |
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 | What you'll pay | |
|---|---|---|
| Ambulatory Surgical Center Ambulatory Surgical Center 2 $0 copay - $200 copay | $0 copay - $200 copay | |
| Diabetes Monitoring Supplies Diabetes Monitoring Supplies 2 $0 copay for covered brands | $0 copay for covered brands | |
| Diagnostic Radiology Services (such as MRIs/CT scans, etc.) Diagnostic Radiology Services (such as MRIs/CT scans, etc.) $0 copay - $85 copay | $0 copay - $85 copay | |
| Diagnostic Tests and Procedures, non-radiological (such as EKG/ECG tests, etc.) Diagnostic Tests and Procedures, non-radiological (such as EKG/ECG tests, etc.) $20 copay | $20 copay | |
| 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 $185 copay for ground or air$185 copay for ground or air | $185 copay for ground or air | |
| Home Health Care Home Health Care $0 copay | $0 copay | |
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Inpatient Hospital Care
Inpatient Hospital Care
$250 copay per day: Days 1-5; $0 copay per day for unlimited days after that |
$250 copay per day: Days 1-5; $0 copay per day for unlimited days after that |
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| Lab Services Lab Services $0 copay | $0 copay | |
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Mental Health (outpatient)
Mental Health (outpatient)
Group: $15 copay Individual: $25 copay |
Group: $15 copay Individual: $25 copay |
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| Opioid Treatment Services Opioid Treatment Services $0 copay | $0 copay | |
| Outpatient Hospital Services (includes observation services) Outpatient Hospital Services (includes observation services) 2 $0 copay - $250 copay | $0 copay - $250 copay | |
| Outpatient X-rays Outpatient X-rays $15 copay | $15 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 for covered services | |
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Skilled Nursing Facility
Skilled Nursing Facility
$0 copay per day: Days 1-20 $196 copay per day: Days 21-45 $0 copay per day: Days 46-100 |
$0 copay per day: Days 1-20 $196 copay per day: Days 21-45 $0 copay per day: Days 46-100 |
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| 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) | |
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 yearNo Coverage | $0 copay; 1 per year | No Coverage |
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Routine Eyewear
Routine Eyewear
3
$0 copay Plan pays up to $200 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 $200 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 $200 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). |
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| Hearing Exam Hearing Exam 3 $0 copay; 1 per yearNo Coverage | $0 copay; 1 per year | No Coverage |
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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). |
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| Fitness Program through Renew Active® Fitness Program through Renew Active® $0 copay for Renew Active, which includes a free gym membership, plus online fitness classes and brain health challenges.$0 copay for Renew Active, which includes a free gym membership, plus online fitness classes and brain health challenges. | $0 copay for Renew Active, which includes a free gym membership, plus online fitness classes and brain health challenges. | |
| Annual Routine Physical Annual Routine Physical 4 $0 copay; 1 per yearNo Coverage | $0 copay; 1 per year | No Coverage |
| Foot Care - Routine Foot Care - Routine 3 $25 copay; 6 visits per yearNo Coverage | $25 copay; 6 visits per year | No Coverage |
| 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 $60 credit per quarter to buy covered OTC products.$60 credit per quarter to buy covered OTC products. | $60 credit per quarter to buy covered OTC products. | |
| Personal Emergency Response System (PERS) Personal Emergency Response System (PERS) $0 copay for a PERS monitoring device that can quickly connect you to the help you need, 24 hours a day.$0 copay for a PERS monitoring device that can quickly connect you to the help you need, 24 hours a day. | $0 copay for a PERS monitoring device that can quickly connect you to the help you need, 24 hours a day. | |
| 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. | |
Plan Documents
Important documents that provide the details you need about this plan's coverage and benefits, prescription drugs, enrollment, providers and more.
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General Plan Information
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| Medical Providers | |
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Prescription Drug Coverage
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| Pharmacy Directory |
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General Plan Information
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Medical Providers
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Prescription Drug Coverage
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| Pharmacy Directory |
Footnotes & Disclaimers
Footnotes
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.
2 Amounts may vary depending on the level of care provided or the type of health care services you receive.
3 Benefits, features and/or devices may vary by plan/area. Limitations and exclusions apply. See the Summary of Benefits (PDF) in the Plan Documents section for details.
4 Benefits, features and/or devices may vary by plan/area. Limitations and exclusions apply. See the Evidence of Coverage (PDF) in the Plan Documents section for details.
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.
6 Coverage Gap Stage:
NOTE: Only applies to plans with prescription drug coverage.
Amounts displayed do not include taxes or injection fees.
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.
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.
If your drug is not eligible for coverage under Medicare Part D, you will pay the full cost of the drug.
8 Optum Mail Home Delivery:
NOTE: Only applies to plans with prescription drug coverage.
2024 Savings Benefit
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 $5,030.
2023 Savings Benefit
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.
Optum Rx is an affiliate of UnitedHealthcare Insurance Company. Optum Home Delivery is a service of Optum Rx pharmacy. You are not required to use Optum Home Delivery to obtain 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 Optum Rx 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 Optum Rx anytime at 1-877-266-4832 (TTY 711).
$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.
Disclaimers
PPO plans:
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.
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.
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.
View the UnitedHealthcare Prescription Drug Transition Process.
Information for plans with prescription drug coverage
The list of covered drugs was last updated on 10/01/2023.
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".
Copay or coinsurance amounts may change if you have a limited income.
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. 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.
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.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
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 “network pharmacies” 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 plan’s formulary. Please contact UnitedHealthcare for details.
UnitedHealthcare has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area.
The pharmacy directory is current as of the first Sunday of each month.
NOTE: If you are receiving Extra Help from Medicare, your copays may be lower or you may have no copays.
Enrollment disclaimer information
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in these plans depends on the plan’s 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 recommendations for individuals. UnitedHealthcare contracts directly with Walgreens for this plan; AARP and its affiliates are not parties to that contractual relationship.
Dental (routine/comprehensive):
Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may 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. Provider network may vary in local market. Dental network size based on Zelis Network360, May 2023.
Hearing:
Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Other hearing exam providers are available in the UnitedHealthcare network. The plan only covers hearing aids from a UnitedHealthcare Hearing network provider. Provider network size may vary by local market.
Network:
Provider network may vary in local market. Provider network size based on Zelis Network360, May 2023.
Over-the-Counter (OTC):
Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Food/OTC/Utilities 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, exclusions and/or network restrictions may apply. You must have a working landline and/or cellular phone coverage to use PERS.
Renew Active:
The Renew Active® Program varies by plan/area and may not be available on all plans. Participation in the Renew Active® program is voluntary. Consult your doctor prior to beginning an exercise program or making changes to your lifestyle or health care routine. Renew Active includes standard fitness membership and other offerings.
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 and plan. Gym network size is based on comparison of competitor’s website data as of May 2023.
Transportation:
Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Routine transportation not for use in emergencies.
Vision:
Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Additional charges may apply for out-of-network items and services. Provider and retail network may vary in local market. Vision retail locations include retailer websites. Annual routine eye exam and $100-$400 allowance for contacts or designer frames, with standard (single, bi-focal, tri-focal or standard progressive) lenses covered in full either annually or every two years. Savings based on comparison to retail. Other vision providers are available in our network.
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.
Esta información está disponible sin costo en otros idiomas. Para obtener más información comuníquese con nuestro Servicio al Cliente.
本資訊可以其他語言免費提供。如需更多資訊，請聯絡客戶服務部。
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