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UHC Sharp Medicare Advantage CA-001P (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Sharp Medicare Advantage CA-001P (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Sharp Medicare Advantage CA-001P (HMO-POS) in 2025, please refer to our full plan details page.
UHC Sharp Medicare Advantage CA-001P (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in San Diego County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that UHC Sharp Medicare Advantage CA-001P (HMO-POS) 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 UHC Sharp Medicare Advantage CA-001P (HMO-POS).
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 UHC Sharp Medicare Advantage CA-001P (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $175.00 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 Maximum Out-Of-Pocket cost of $3300.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 UHC Sharp Medicare Advantage CA-001P (HMO-POS) plan has a $175 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, a standard generic drug will cost you a $47 copay. For preferred brand drugs, you will pay a $100 copay, regardless of the pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The UHC Sharp Medicare Advantage CA-001P (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a $260 copay for the first week and no copay thereafter, and outpatient services with varying copays. The plan also covers emergency services, primary care, preventive services, and home health services with no copay. Additional benefits include hearing exams, vision services, and dental services with varying copays or coinsurance. The plan also covers ambulance services with a $155 copay and offers coverage for medical equipment and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric services, are covered. For Acute services, you'll pay a $260 copay for days 1-7, and no copay for days 8-90, while additional days 91-999 have no copay; Non-Medicare-covered stays and upgrades are not covered. For Psychiatric services, you'll pay a $260 copay for days 1-7, and no copay for days 8-90, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay between $0 and $250, Observation Services with a $250 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual Sessions for Outpatient Substance Abuse with a copay between $0 and $25, Group Sessions for Outpatient Substance Abuse with a $15 copay, and Outpatient Blood Services with no copay. Prior authorization and a doctor referral are required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Sharp Medicare Advantage CA-001P (HMO-POS) plan. Ground and air ambulance services have a $155 copay, with no coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UHC Sharp Medicare Advantage CA-001P (HMO-POS) plan. Emergency Services have a $140 copay, Urgently Needed Services have a copay between $0 and $30, and Worldwide Emergency, Urgent, and Transportation Services have no copay.
Primary Care See details
The UHC Sharp Medicare Advantage CA-001P (HMO-POS) plan covers primary care physician services with a copay between $0 and $5, chiropractic services with a $15 copay, and occupational therapy services with a copay between $0 and $35. The plan also covers physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services, all with varying copays. Routine Chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional preventive services, Kidney Disease Education Services, and other preventive services. Fitness benefits and Home and Bathroom Safety Devices and Modifications are covered with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with no copay, while routine hearing exams are limited to 1 per year with no copay. Prescription hearing aids are covered with a copay between $199 and $1249 for all types, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered with a copay between $99 and $829.
Vision Services See details
Vision services include eye exams with a $35 copay, routine eye exams with no copay, and eyewear with no copay for contact lenses and eyeglass frames, and a copay of $0 - $153 for eyeglass lenses. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a 20% coinsurance, and other services like oral exams, dental x-rays, cleaning, fluoride treatment, and other preventive dental services with no copay. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Sharp Medicare Advantage CA-001P (HMO-POS) plan. There is no copay for dialysis services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and outpatient X-ray services are covered. Diagnostic procedures/tests and lab services have no copay, while outpatient X-ray services have a $10 copay. Diagnostic radiological services have a copay of at most $95, and therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the UHC Sharp Medicare Advantage CA-001P (HMO-POS) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the listed sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor referral. There is no copay for days 1-20, and a $203 copay for days 21-100, with no coinsurance.
Other Services See details
Under the "Other Services" benefit, over-the-counter (OTC) items and meal benefits are covered with no copay, while acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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