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AARP Medicare Advantage from UHC CA-43 (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-43 (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-43 (HMO-POS) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC CA-43 (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2026 to people living in Orange 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-43 (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-43 (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-43 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $55.00. 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 $800.00 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 AARP Medicare Advantage from UHC CA-43 (HMO-POS)
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Drug Coverage
The AARP Medicare Advantage from UHC CA-43 (HMO-POS) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $355.00. After meeting this deductible, you will pay no copay for Tier 1 preferred generic drugs at standard pharmacies. For other tiers at standard pharmacies, you will pay an 18% coinsurance for standard generics, 40% coinsurance for preferred brands, and 29% coinsurance for non-preferred drugs. Once 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 prescription drugs. Additionally, individuals who qualify for the Low-Income Subsidy can see their Part D premium reduced from $55.00 to $43.00.
Additional Benefits
The AARP Medicare Advantage from UHC CA-43 (HMO-POS) plan offers comprehensive medical coverage with no copays and no coinsurance for many essential services. Members enjoy no copays for inpatient hospital stays, primary care and specialist visits, preventive care, and outpatient hospital services. Emergency care is available with a $150 copay, which is waived if you are admitted, while urgent care services require a $0 to $20 copay. For supplemental health needs, the plan provides routine vision and preventive dental care with no copay, though comprehensive dental services require a 50% coinsurance up to a $5,000 annual limit. Routine hearing exams and up to 48 one-way transportation trips per year to approved locations are also covered with no copay. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by AARP Medicare Advantage from UHC CA-43 (HMO-POS), featuring no copay and no coinsurance for Medicare-covered acute and psychiatric stays. Prior authorization and doctor referrals are required, while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC CA-43 (HMO-POS) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, and blood services with no copay and no coinsurance. Outpatient substance abuse services are also covered with no coinsurance, requiring a $15 copay for group sessions and a copay ranging from no copay to $25 for individual sessions.
Partial Hospitalization See details
AARP Medicare Advantage from UHC CA-43 (HMO-POS) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Accessing this covered service requires both a doctor referral and prior authorization.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC CA-43 (HMO-POS) covers ground and air ambulance services with a $200 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, whereas transportation to any health-related location is not covered.
Emergency Services See details
AARP Medicare Advantage from UHC CA-43 (HMO-POS) covers emergency services 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 $0 to $20 copay 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-43 (HMO-POS) covers primary care, specialist, physical therapy, chiropractic, and telehealth services with no copay and no coinsurance. Mental health and psychiatric care are also covered with no coinsurance, requiring copays of $0 to $25 for individual sessions and $15 for group sessions.
Preventive Services See details
AARP Medicare Advantage from UHC CA-43 (HMO-POS) partially covers preventive services with no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and kidney disease education. Non-covered services include health education, personal emergency response systems, weight management, therapeutic massage, alternative therapies, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, 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-43 (HMO-POS), which provides one routine hearing exam per year with no copay or coinsurance, but does not cover fitting or evaluation exams. Prescription and OTC hearing aids are covered up to two devices per year with no coinsurance and copays ranging from $199.00 to $1,249.00 and $199.00 to $829.00, respectively. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are partially covered by AARP Medicare Advantage from UHC CA-43 (HMO-POS), featuring no deductibles, copays, or coinsurance for routine eye exams, contact lenses, and eyeglass frames. Eyeglass lenses are covered with a $0 to $153 copay and no coinsurance under a combined $300 eyewear limit every two years, while upgrades and eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage from UHC CA-43 (HMO-POS) partially covers dental services up to a $5,000 annual maximum, offering preventive care such as cleanings, exams, and X-rays with no copay. Comprehensive treatments like restorative care, endodontics, and oral surgery require a 50% coinsurance, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC CA-43 (HMO-POS) covers home infusion bundled services with prior authorization, featuring no copay and between no coinsurance and 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered Part B insulin drugs require a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by AARP Medicare Advantage from UHC CA-43 (HMO-POS) with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to access this benefit.
Medical Equipment See details
AARP Medicare Advantage from UHC CA-43 (HMO-POS) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage from UHC CA-43 (HMO-POS), requiring prior authorization and doctor referrals. Members pay no copay and no coinsurance for diagnostic tests, lab services, diagnostic radiology, and outpatient X-rays, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
AARP Medicare Advantage from UHC CA-43 (HMO-POS) covers Home Health Services with no copay and no coinsurance. To receive these benefits, a doctor referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically offered by AARP Medicare Advantage from UHC CA-43 (HMO-POS) and some services are covered, but in practice, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. Because these services are not covered in practice, there is no plan copay or coinsurance coverage available for them.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by AARP Medicare Advantage from UHC CA-43 (HMO-POS), requiring prior authorization and a doctor referral, though additional days beyond Medicare-covered are not covered. There is no copay and no coinsurance for days 1 to 20, followed by a $100 copay and no coinsurance for days 21 to 100.
Other Services See details
AARP Medicare Advantage from UHC CA-43 (HMO-POS) partially covers other services, providing acupuncture and over-the-counter items with no copay and no coinsurance. Meal benefits and dual eligible SNPs with highly integrated services are not covered.
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