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AARP Medicare Advantage from UHC CA-0012 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC CA-0012 (HMO-POS). 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 CA-0012 (HMO-POS) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC CA-0012 (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 4 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage from UHC CA-0012 (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 AARP Medicare Advantage from UHC CA-0012 (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 AARP Medicare Advantage from UHC CA-0012 (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 $355.00 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 $2500.00 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 AARP Medicare Advantage from UHC CA-0012 (HMO-POS) plan features an annual prescription drug deductible of $355.00 before initial coverage begins. During the initial coverage phase, standard pharmacy costs include a $5.00 copay for Tier 1 preferred generic drugs, 18% coinsurance for Tier 2 standard generics, and 37% coinsurance for Tier 3 preferred brands. Tier 4 non-preferred drugs require a 29% coinsurance at standard pharmacies as well as through preferred and standard mail order. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescription drugs. Additionally, individuals who qualify for the full low-income subsidy will pay no premium for Part D.
Additional Benefits
The AARP Medicare Advantage from UHC CA-0012 (HMO-POS) plan offers robust core medical coverage, featuring no copay for primary care visits, specialist consultations, telehealth, and preventive services. For hospital care, inpatient stays require a $295 copay for days 1 through 7 and no copay for days 8 through 90, while emergency room visits carry a $150 copay which is waived upon admission. Outpatient surgery, lab tests, and home health services are available with no copay, though diagnostic radiology carries a copay of up to $95. Additional benefits include routine dental cleanings, vision exams, and hearing exams with no copay, though copays apply for prescription hearing aids and eyeglass lenses. Durable medical equipment and dialysis services require a 20% coinsurance with no copay, while Part B insulin is capped at a $35 copay with up to 20% coinsurance. To support overall wellness, the plan also provides no copay for over-the-counter items and up to 12 free one-way trips to approved health locations.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by AARP Medicare Advantage from UHC CA-0012 (HMO-POS), requiring a $295 copay for days 1 to 7 and no copay or coinsurance for days 8 to 90 for both acute and psychiatric stays. Additional acute days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC CA-0012 (HMO-POS) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Copays for other services range from no copay to $295 for outpatient hospital visits and up to $25 for outpatient substance abuse sessions.
Partial Hospitalization See details
AARP Medicare Advantage from UHC CA-0012 (HMO-POS) covers partial hospitalization benefits with a $55 copay and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC CA-0012 (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by AARP Medicare Advantage from UHC CA-0012 (HMO-POS) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay of $0 to $30 and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
AARP Medicare Advantage from UHC CA-0012 (HMO-POS) covers primary care, specialist visits, and telehealth with no copay and no coinsurance, though podiatry services are not covered. Patients pay a $10 copay for routine chiropractic care, a $35 copay for physical, occupational, and speech therapies, and up to a $25 copay for mental health and psychiatric services, with no coinsurance required for these benefits.
Preventive Services See details
Preventive services are covered under the AARP Medicare Advantage from UHC CA-0012 (HMO-POS) plan with no copay and no coinsurance for annual physicals, kidney disease education, diabetes training, and fitness benefits. However, additional preventive services are only partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, massages, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC CA-0012 (HMO-POS) with no annual deductible. One routine hearing exam is covered each year with no copay or coinsurance, though fitting and evaluation services, along with inner, outer, and over the ear prescription hearing aids, are not covered. Covered OTC and prescription hearing aids are limited to two per year with no coinsurance and copays ranging from $199 to $829 for OTC and $199 to $1,249 for prescription devices.
Vision Services See details
Vision Services are partially covered by AARP Medicare Advantage from UHC CA-0012 (HMO-POS), with upgrades and combined eyeglasses (lenses and frames) excluded from coverage. Routine eye exams, contact lenses, and eyeglass frames are offered with no copay and no coinsurance, while eyeglass lenses have a copay of up to $153 and no coinsurance, up to a $150 combined eyewear limit every two years.
Dental Services See details
Dental services are partially covered by AARP Medicare Advantage from UHC CA-0012 (HMO-POS), featuring no copay and no coinsurance for preventive care such as cleanings, oral exams, x-rays, and fluoride. However, several major services are not covered, including restorative treatments, endodontics, periodontics, prosthodontics, oral surgery, implants, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered under AARP Medicare Advantage from UHC CA-0012 (HMO-POS) with prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by AARP Medicare Advantage from UHC CA-0012 (HMO-POS) with 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
AARP Medicare Advantage from UHC CA-0012 (HMO-POS) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC CA-0012 (HMO-POS) covers diagnostic and radiological services, offering lab tests and diagnostic procedures with no copay and no coinsurance. Diagnostic radiology services carry no coinsurance and a copay up to $95, outpatient X-rays require a $15 copay with no coinsurance, and therapeutic radiology incurs a 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by AARP Medicare Advantage from UHC CA-0012 (HMO-POS) with no copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under AARP Medicare Advantage from UHC CA-0012 (HMO-POS), as none of the sub-services, including Cardiac, Intensive Cardiac, Pulmonary, and SET for PAD rehabilitation, are covered by the plan.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC CA-0012 (HMO-POS) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and a doctor referral. The plan features no coinsurance, with no copay for days 1 to 20 and a $218 daily copay for days 21 to 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
AARP Medicare Advantage from UHC CA-0012 (HMO-POS) partially covers other services, offering acupuncture for a $10 copay and no coinsurance for up to 12 treatments per year, and over-the-counter items with no copay and no coinsurance. Meal benefits and highly integrated Dual Eligible SNPs are not covered.
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