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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 2025, 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 3 out of 5 stars in 2025.
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 $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 $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:
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Drug Coverage
The UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) plan has a $175 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at a preferred pharmacy. For preferred brand drugs, you'll pay a $100 copay. Non-preferred drugs have a 31% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) plan offers comprehensive coverage with a variety of benefits. You will have no copays for primary care visits, preventive services, routine hearing and vision exams, and many dental services. You'll also find no copays for home health services and dialysis services. This plan includes copays for inpatient hospital stays, outpatient services, and emergency services, as well as specialized services such as partial hospitalization, and ambulance services. Additionally, the plan covers hearing aids, eyewear, and home infusion services, with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For acute inpatient hospital stays, you'll pay a $225 copay for days 1-7, and no copay for days 8-90; additional days (91-999) have no copay. Inpatient psychiatric stays also have a $225 copay for days 1-7, and no copay for days 8-90. Non-Medicare-covered stays and upgrades for acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $100, and observation services with a $100 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have copays of $0-$25 for individual sessions and $15 for group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) plan, requiring prior authorization and a doctor referral. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS). Ground and Air Ambulance Services have a $275 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 ValueRx CA-12P (HMO-POS) plan. Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a copay between $0 and $30 with no coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, and additional telehealth benefits have no copay, while occupational therapy services, individual mental health and psychiatric sessions have a copay between $0 and $35, and group mental health and psychiatric sessions have a $15 copay; physical therapy and speech-language pathology services have a copay between $0 and $35.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, Annual Physical Exams with no copay, and additional preventive services, including Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. 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, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with no copay, and prescription hearing aids and OTC hearing aids with copays ranging from $99 to $1249. Fitting/Evaluation for Hearing Aid, 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 eye exams and eyewear, with a doctor referral required for both. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear has no copay, with a combined maximum benefit of $300 every two years, though eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (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, and oral and maxillofacial surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, but require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor referral. There is no copay for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, Diagnostic Radiological Services with a copay of up to $95, Therapeutic Radiological Services with coinsurance of at least 20%, and Outpatient X-Ray Services with a $10 copay. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered under the UHC Sharp Medicare Advantage ValueRx CA-12P (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 not covered by the UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) plan. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) plan. There is no copay for days 1-20, but a $203 copay applies for days 21-100; additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under "Other Services," acupuncture and over-the-counter items are covered with no copay, while the meal benefit is covered with no copay and requires prior authorization. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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