Look for the green-colored pricing as you shop for plans to see your potential cost savings shown by the crossed out dollar amount.
The information provided in this document may be subject to change over time and may become outdated. For the most current and up-to-date information, please refer to our website at UHC.com/medicare.
new former $0
when using an in and out-of-network provider
when using an in and out-of-network provider
Covered for urgent and emergency care only
to talk with a network telehealth provider online through live audio and video.
for covered services
for covered services
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.
per stay for unlimited days
per stay for unlimited days
per day: days 1-100
per day: days 1-100
per visit ($0 copay when outside of the United States)
per visit ($0 copay when outside of the United States)
for ground or air
if you qualify for Extra Help
for Tier 1
$615for Tiers 2-5 if you do not qualify for Extra Help
Standard network
Standard network
Standard network
Standard network
Standard network
Standard network
per year toward covered preventive and comprehensive services.
for covered preventive services such as oral exams, routine cleanings, X-rays and fluoride
for all covered comprehensive services, such as fillings, crowns, root canals, extractions, bridges and dentures
See more of the benefits and programs offered by this plan that are not provided under Original Medicare.
for standard prescription lenses
$200 allowanceevery year for 1 pair of lenses/frames or contacts.
up to 2 hearing aids every 2 years
per month for OTC products and wellness support, plus healthy food and utilities for members with a qualifying condition such as diabetes, cardiovascular disorders, chronic heart failure, chronic high blood pressure and/or chronic high cholesterol. Buy first aid supplies, pain relievers, fruits, meat and more or pay home utilities like electricity or internet. Get wellness support including in-home services, select fitness items and more.
per month for OTC products and wellness support, plus healthy food and utilities for members with a qualifying condition such as diabetes, cardiovascular disorders, chronic heart failure, chronic high blood pressure and/or chronic high cholesterol. Buy first aid supplies, pain relievers, fruits, meat and more or pay home utilities like electricity or internet. Get wellness support including in-home services, select fitness items and more.
in rewards every year for getting an annual wellness visit, being physically active, connecting with others and more.
in rewards every year for getting an annual wellness visit, being physically active, connecting with others and more.
for Renew Active®, which includes a free membership at core and premium gyms, plus online fitness classes and brain health challenges.
for Renew Active®, which includes a free membership at core and premium gyms, plus online fitness classes and brain health challenges.
for 28 home-delivered meals immediately after an inpatient hospitalization or skilled nursing facility (SNF) stay.
Important documents that provide the details you need about this plan's coverage and benefits, prescription drugs, enrollment, providers and more.
Enrollment Disclaimer Information:
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. For Medicare Advantage and/or Prescription Drug Plans: A Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. For Dual Special Needs Plans: A Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan's contract renewal with Medicare.
AARP-related Disclaimer:
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 in a Medicare Advantage or Prescription Drug Plan. AARP encourages you to consider your needs when selecting products and does not make specific product recommendations for individuals. AARP does not employ or endorse agents, producers or brokers.
Extra Help:
If you are receiving Extra Help from Medicare, your copays may be lower or you may have no copays.
Out-of-network:
Out-of-network/non-contracted providers are under no obligation to treat 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.
The Medicare Prescription Payment Plan:
If you have high out-of-pocket costs for your covered Part D prescription drugs each year, you may want to participate in the Medicare Prescription Payment Plan. This payment plan spreads your out-of-pocket prescription drug costs over the remainder of the calendar year. Learn more about the Medicare Prescription Payment Plan.
Out-of-network:
Out-of-network/non-contracted providers are under no obligation to treat 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.
State-Level Medicaid, D-SNP Disclaimer:
D-SNP and C-SNP: The values shown in-network represent a range based upon the amount of the Medicare Parts A and B plan cost sharing covered by the state. Depending on your Medicaid eligibility, your Medicaid program may have cost sharing. For complete information, and for costs for those without Medicare Parts A and B plan cost sharing covered by the state, and applicable Medicaid cost sharing, please refer to your Summary of Benefits or Evidence of Coverage. Limitations, exclusions, and restrictions may apply.
Other Languages:
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。
Supporting you through your Medicare journey
Chat is currently unavailable.�
Please try again later.
�