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AARP Medicare Advantage from UHC WI-0007 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC WI-0007 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AARP Medicare Advantage from UHC WI-0007 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC WI-0007 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage from UHC WI-0007 (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about AARP Medicare Advantage from UHC WI-0007 (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For AARP Medicare Advantage from UHC WI-0007 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $89.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $600.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6700.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $6700.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The AARP Medicare Advantage from UHC WI-0007 (PPO) plan features an annual prescription drug deductible of $600. For Tier 1 preferred generic drugs, members pay no copay for 1-month and 3-month supplies at standard pharmacies or through mail order. Tier 2 generic medications are also highly affordable, with no copay for a 3-month preferred mail order supply, or a $10 copay for a 1-month supply at standard pharmacies. Brand-name and specialty drugs under this plan require coinsurance instead of flat copayments. Tier 3 preferred brand drugs require a 16% coinsurance, while Tier 4 non-preferred drugs carry a 36% coinsurance for a 1-month supply. Specialty Tier 5 medications have a 26% coinsurance for a 1-month supply at standard pharmacies and through mail order.
Additional Benefits
The AARP Medicare Advantage from UHC WI-0007 (PPO) plan offers robust coverage for everyday healthcare needs with no copays and no coinsurance for primary care visits, annual physicals, routine vision and hearing exams, and preventive dental cleanings. Home health services and laboratory tests are also covered with no copays. For specialist visits, beneficiaries can expect a copay ranging from $0 to $60 with no coinsurance. For major medical care, inpatient hospital stays require a $550 daily copay for the first few days, while skilled nursing facility stays require no copay for the first 20 days and a $218 daily copay for days 21 through 100. Emergency room visits carry a $130 copay, and ambulance services require a $290 copay. Additionally, services such as dialysis, durable medical equipment, and Medicare-covered dental care require a 20% coinsurance with no copay.
Inpatient Hospital See details
AARP Medicare Advantage from UHC WI-0007 (PPO) offers partially covered inpatient hospital services with no coinsurance, requiring a $550 daily copay for days 1 through 5 for acute stays and days 1 through 4 for psychiatric stays, followed by no copay for remaining covered days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC WI-0007 (PPO) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require copays ranging from $0 to $550, while outpatient substance abuse services carry copays up to $25, with prior authorization required for most of these services.
Partial Hospitalization See details
AARP Medicare Advantage from UHC WI-0007 (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance services under AARP Medicare Advantage from UHC WI-0007 (PPO) are covered with a $290 copay and no coinsurance for both ground and air transport, although prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services under the AARP Medicare Advantage from UHC WI-0007 (PPO) plan are covered with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services feature a copay ranging from no copay to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance. These cost-sharing amounts do not count toward the plan-level deductible.
Primary Care See details
Primary Care benefits under the AARP Medicare Advantage from UHC WI-0007 (PPO) plan offer primary care visits and telehealth with no copay and no coinsurance, though chiropractic services are not covered. Specialist visits require a $0 to $60 copay, therapy services cost a $50 to $60 copay, and podiatry visits have a $45 copay, all with no coinsurance.
Preventive Services See details
Preventive Services are covered by AARP Medicare Advantage from UHC WI-0007 (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, and select screenings. This benefit is partially covered, as it does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, bathroom safety, and counseling.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC WI-0007 (PPO), including one annual routine hearing exam with no copay and no coinsurance, while fitting and evaluation exams are not covered. Up to two prescription hearing aids with a $199 to $1,249 copay and two OTC hearing aids with a $199 to $829 copay are covered per year with no coinsurance, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by AARP Medicare Advantage from UHC WI-0007 (PPO) with no deductible and no coinsurance, offering one routine eye exam annually with no copay, while other eye exam services are not covered. Eyewear benefits include no coinsurance and a $150 combined limit every two years, with no copay for contacts and frames and a $0 to $153 copay for lenses, though upgrades and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage from UHC WI-0007 (PPO) offers partially covered dental services, featuring Medicare-covered dental care with no copay and a 20% coinsurance, as well as preventive services like cleanings, exams, and x-rays with no copay and no coinsurance. Specialized services—including restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic treatments—are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by AARP Medicare Advantage from UHC WI-0007 (PPO) with no copay, though prior authorization is required. Covered Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
AARP Medicare Advantage from UHC WI-0007 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for this covered benefit.
Medical Equipment See details
AARP Medicare Advantage from UHC WI-0007 (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are offered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC WI-0007 (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. There is no copay for lab services and some diagnostic radiology, while diagnostic tests require a $25 copay, outpatient X-rays require a $30 copay, and therapeutic radiology services require a minimum $60 copay.
Home Health Services See details
Home health services are covered by the AARP Medicare Advantage from UHC WI-0007 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
AARP Medicare Advantage from UHC WI-0007 (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC WI-0007 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by AARP Medicare Advantage from UHC WI-0007 (PPO), which features a meal benefit for chronic illnesses with no copay and no coinsurance, though prior authorization is required. Acupuncture and Over-the-Counter (OTC) items are not covered under this plan.
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