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UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Sharp Medicare Advantage ValueRx CA-12P (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 ValueRx CA-12P (HMO-POS) in 2026, please refer to our full plan details page.
UHC Sharp Medicare Advantage ValueRx CA-12P (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 UHC Sharp Medicare Advantage ValueRx CA-12P (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 ValueRx CA-12P (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 ValueRx CA-12P (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 $2900.00 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:
Sign up for UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS)
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Drug Coverage
The UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) plan features an annual prescription drug deductible of $355.00. During the initial coverage phase, members enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies, though standard pharmacies require a $20.00 copay. For other tiers, costs transition to coinsurance, including 23% for Tier 2 standard generics and 25% for Tier 3 preferred brands. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, individuals who qualify for the low-income subsidy (LIS) will see their Part D cost-sharing reduced to $0.00.
Additional Benefits
The UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) plan offers comprehensive coverage with no copay for primary care visits, specialist consultations, telehealth, and annual physicals. For urgent and emergency needs, emergency room visits carry a $150 copay which is waived if admitted, while covered ambulance services require a $275 copay. Inpatient hospital stays require a $225 daily copay for the first seven days, after which there is no copay for days eight through 90. Routine dental cleanings, annual eye exams, and routine hearing tests are covered with no copay, although corrective lenses and hearing aids require varying copays. Dialysis and home health services also feature no copay, while durable medical equipment and prosthetics require a 20% coinsurance. Additionally, diagnostic lab tests and outpatient X-rays are highly affordable, ranging from no copay to a $10 copay.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS), with acute and psychiatric stays requiring a $225 daily copay for days 1 through 7 and no copay or coinsurance for days 8 through 90. While unlimited additional acute stay days are covered at no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) with no coinsurance and variable copays depending on the service. Patients will pay no copay for ambulatory surgical center and blood services, a $100 daily copay for observation services, and copays ranging from $0 to $100 for outpatient hospital visits and substance abuse therapy.
Partial Hospitalization See details
Partial hospitalization benefits are covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) with a $55.00 copay and no coinsurance. This benefit requires both a doctor referral and prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) plan, as transportation services to both plan-approved and any health-related locations are not covered. Covered ground and air ambulance services require a $275 copay and no coinsurance.
Emergency Services See details
UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) covers emergency services with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require no copay to a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS), as podiatry services are not covered. Covered services require no coinsurance, featuring no copay for primary care, specialists, telehealth, and routine chiropractic visits, a $35 copay for physical, occupational, and speech therapies, and copays ranging from $0 to $25 for mental health and psychiatric sessions.
Preventive Services See details
Preventive services are covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) with no copay and no coinsurance for annual physicals, kidney disease education, and screenings. However, additional supplemental benefits are only partially covered; fitness benefits and home safety devices have no copay, but health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) partially covers hearing services, offering routine hearing exams with no copay or coinsurance, and prescription or OTC hearing aids with a $199 to $1,249 copay and no coinsurance. Fitting and evaluation exams, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS), featuring annual routine eye exams with no copay and no coinsurance. Covered eyewear includes contact lenses and frames with no copay and no coinsurance, and lenses with a $0 to $153 copay and no coinsurance up to a $150 allowance every two years, while upgrades and combined eyeglasses are not covered.
Dental Services See details
Dental services are partially covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS), with exams, cleanings, x-rays, fluoride, and Medicare-covered dental available with no copay and no coinsurance. Restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, maxillofacial prosthetics, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) covers home infusion bundled services, requiring prior authorization for coverage. Medicare Part B insulin drugs feature a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) plan with no copay and no coinsurance. Prior authorization and a doctor referral are required to access this benefit.
Medical Equipment See details
Medical equipment is covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS), with durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes requiring a 20% coinsurance and no copay. Diabetic supplies are covered with no copay, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) with no copay or coinsurance for lab services and diagnostic tests. Outpatient X-rays require a $10 copay with no coinsurance, diagnostic radiological services carry a copay of up to $95 with no coinsurance, and therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by UHC Sharp Medicare Advantage ValueRx CA-12P (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 the UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) plan, meaning there is no coverage for intensive cardiac, pulmonary, or SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS), requiring prior authorization and a doctor referral. Covered stays feature no copay for days 1 to 20 and a $218 daily copay for days 21 to 100, with no coinsurance, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS), offering acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance. Dual eligible SNPs with highly integrated services are not covered under this plan.
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