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AARP Medicare Advantage from UHC CA-0016 (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-0016 (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-0016 (HMO-POS) in 2025, please refer to our full plan details page.
AARP Medicare Advantage from UHC CA-0016 (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in San Luis Obispo County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that AARP Medicare Advantage from UHC CA-0016 (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-0016 (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-0016 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.00. 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 $255.00 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 $3400.00 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-0016 (HMO-POS) plan has a $255 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, a standard generic drug will have a $10 copay, while a preferred brand drug will have a $100 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your monthly plan premium may be reduced.
Additional Benefits
The AARP Medicare Advantage from UHC CA-0016 (HMO-POS) plan offers a range of benefits with varying costs. For hospital stays, you'll pay a $395 copay for the first 6 days, and no copay for the rest. Outpatient services have copays between $0 and $395 depending on the service. The plan also covers primary care with no copay, along with preventive services, hearing, vision, and dental care. There is also coverage for ambulance services, emergency services, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered. For Inpatient Hospital-Acute, you will pay a $395 copay for days 1-6, and no copay for days 7-90, and no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $395 copay for days 1-6, and no copay for days 7-90, and no coinsurance. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $395, observation services have a $395 copay, ASC services have no copay, individual outpatient substance abuse sessions have a copay between $0 and $25, group outpatient substance abuse sessions have a $15 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by AARP Medicare Advantage from UHC CA-0016 (HMO-POS). Ground and air ambulance services have a copay of $290, with no coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services, are covered under the AARP Medicare Advantage from UHC CA-0016 (HMO-POS) plan. Emergency services have a $140 copay with no coinsurance, while urgently needed services have a copay between $0 and $65 with no coinsurance. Worldwide Emergency Services are also covered, with no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $10 copay (prior authorization and a doctor referral are required, but routine care is not covered), Occupational Therapy Services with a $0 - $10 copay (authorization and referral are required), Physician Specialist Services with a $0 - $10 copay (prior authorization and a doctor referral are required), Mental Health Specialty Services with a $0 - $25 copay for individual sessions and a $15 copay for group sessions (prior authorization and a doctor referral are required), Other Health Care Professional with no copay (prior authorization and a doctor referral are required), Psychiatric Services with a $0 - $25 copay for individual sessions and a $15 copay for group sessions (prior authorization and a doctor referral are required), Physical Therapy and Speech-Language Pathology Services with a $0 - $10 copay (authorization and referral are required), Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay (prior authorization is required). Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as an annual physical exam with no copay. Additional preventive services, including Fitness Benefit and Home and Bathroom Safety Devices and Modifications are covered with no copay. Other services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing exams are covered with no copay, while routine hearing exams are covered with no copay for one visit every year. Prescription hearing aids are covered with a copay between $199 and $1249 for two visits every year, while OTC hearing aids have a copay between $99 and $829. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services include routine eye exams, eyewear, and contact lenses. Routine eye exams, including services not usually covered by Medicare, have no copay. Eyewear benefits are covered with no copay for contact lenses, and eyeglass frames, but eyeglass lenses have a copay of $0-$153; eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
AARP Medicare Advantage from UHC CA-0016 (HMO-POS) covers dental services, with a 20% coinsurance for Medicare Dental Services. Oral exams, dental X-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatments, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no copay. Prosthodontics (removable and fixed) have a coinsurance between 0% and 50%, and orthodontics and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage from UHC CA-0016 (HMO-POS) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying coinsurance and copays depending on the specific service. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $95, Therapeutic Radiological Services have a copay of $80, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage from UHC CA-0016 (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. A doctor's referral and prior authorization are required for covered services, and the copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the AARP Medicare Advantage from UHC CA-0016 (HMO-POS) plan with prior authorization and a doctor referral required. There is no copay for days 1-20, and a $203 copay for days 21-100, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay. Acupuncture, Meal Benefit, 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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