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AARP Medicare Advantage from UHC TX-0043 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC TX-0043 (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 TX-0043 (HMO-POS) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC TX-0043 (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Texas. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage from UHC TX-0043 (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 TX-0043 (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 TX-0043 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.00. 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 $440.00 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 $4200.00 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 TX-0043 (HMO-POS) plan features an annual drug deductible of $440. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for one-month and three-month supplies filled at standard pharmacies or through standard mail order. This makes everyday generic prescriptions highly affordable under this plan. For higher-tier medications, cost-sharing is based on coinsurance during the initial coverage phase. Tier 3 preferred brand drugs require a 15% coinsurance for one-month and three-month supplies at standard pharmacies and mail order. Tier 4 non-preferred drugs carry a 39% coinsurance, while Tier 5 specialty drugs require a 28% coinsurance, both for one-month supplies.
Additional Benefits
The AARP Medicare Advantage from UHC TX-0043 (HMO-POS) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, routine annual physicals, and home health services. Specialist visits require a copay of up to $20, while inpatient hospital stays cost a $150 daily copay for the first six days and no copay thereafter. Emergency room visits carry a $150 copay, which is waived upon hospital admission, and urgent care visits range from no copay to a $65 copay. For additional wellness benefits, the plan features no copay for routine eye and hearing exams, alongside a $5,000 annual maximum for dental care with no copay for preventive services. Covered medical equipment, dialysis, and Medicare Part B drugs feature no copay and up to 20% coinsurance. Additionally, members can access routine transportation for up to 36 one-way trips per year and select over-the-counter items with no copay.
Inpatient Hospital See details
AARP Medicare Advantage from UHC TX-0043 (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $150 daily copay for days 1-6 and no copay for days 7-90. Unlimited additional acute care days are covered at no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by AARP Medicare Advantage from UHC TX-0043 (HMO-POS) with no coinsurance, though prior authorization and referrals are required for most services. Covered benefits include outpatient hospital services with a $0 to $150 copay, observation services with a $150 daily copay, and outpatient substance abuse sessions with a $0 to $25 copay, while ambulatory surgical center and blood services have no copay.
Partial Hospitalization See details
AARP Medicare Advantage from UHC TX-0043 (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the AARP Medicare Advantage from UHC TX-0043 (HMO-POS) plan, featuring a $275 copay and no coinsurance for both ground and air ambulance rides. Transportation is partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage from UHC TX-0043 (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 no coinsurance and a copay ranging from no copay to $65, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
AARP Medicare Advantage from UHC TX-0043 (HMO-POS) covers primary care and telehealth visits with no copay and no coinsurance, while specialist visits require a $0 to $20 copay and no coinsurance. Physical, occupational, and speech therapy services carry a $20 copay with no coinsurance, and chiropractic services are partially covered because routine and other chiropractic services are not covered.
Preventive Services See details
AARP Medicare Advantage from UHC TX-0043 (HMO-POS) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and fitness programs. However, services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission 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
AARP Medicare Advantage from UHC TX-0043 (HMO-POS) provides partial coverage for hearing services with no coinsurance, including one routine hearing exam per year at no copay. Covered OTC hearing aids require a copay of $199 to $829 and prescription hearing aids require a copay of $199 to $1,249, though hearing aid fittings, evaluations, and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered under the AARP Medicare Advantage from UHC TX-0043 (HMO-POS) plan, featuring no copay and no coinsurance for one routine eye exam per year. Eyewear benefits include a $250 combined maximum limit every two years with no deductible, offering contact lenses and frames with no copay and no coinsurance, and eyeglass lenses with a $0 to $153 copay and no coinsurance, though upgrades and other eye exam services are not covered.
Dental Services See details
AARP Medicare Advantage from UHC TX-0043 (HMO-POS) offers partially covered dental services with a $5,000 annual maximum, featuring no copay and no coinsurance for preventive services, no copay and 20% coinsurance for Medicare-covered dental, and no copay and 50% coinsurance for comprehensive dental care. Implant services and orthodontics are not covered by this plan.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC TX-0043 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance, while Medicare Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage from UHC TX-0043 (HMO-POS) plan with no copay and a 20% coinsurance. Both prior authorization and a referral are required to access this benefit.
Medical Equipment See details
AARP Medicare Advantage from UHC TX-0043 (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay. A 20% coinsurance applies to durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts, and prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under AARP Medicare Advantage from UHC TX-0043 (HMO-POS), with prior authorization and referrals required. There is no copay or coinsurance for lab services, no copay for diagnostic radiological services, a $50 copay with no coinsurance for diagnostic tests, a $30 copay for outpatient X-rays, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
AARP Medicare Advantage from UHC TX-0043 (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by AARP Medicare Advantage from UHC TX-0043 (HMO-POS) with no copay and no coinsurance, although in practice some services are covered but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AARP Medicare Advantage from UHC TX-0043 (HMO-POS) with no coinsurance, requiring no prior three-day hospital stay. There is no copay for days 1 through 20, and a $218 daily copay for days 21 through 100, though prior authorization and referrals are required.
Other Services See details
AARP Medicare Advantage from UHC TX-0043 (HMO-POS) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required to receive the meal benefit.
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