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AARP Medicare Advantage CareFlex from UHC TX-45 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage CareFlex from UHC TX-45 (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 CareFlex from UHC TX-45 (HMO-POS) in 2025, please refer to our full plan details page.
AARP Medicare Advantage CareFlex from UHC TX-45 (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in San Antonio Metro Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that AARP Medicare Advantage CareFlex from UHC TX-45 (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 CareFlex from UHC TX-45 (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 CareFlex from UHC TX-45 (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 $495.00 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 $6700.00 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 CareFlex from UHC TX-45 (HMO-POS)
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Drug Coverage
The AARP Medicare Advantage CareFlex from UHC TX-45 (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a $495 deductible. In the initial coverage phase, after the deductible is met, you'll pay a copay for generic drugs and a copay or coinsurance for brand name and non-preferred drugs depending on the pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The AARP Medicare Advantage CareFlex from UHC TX-45 (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. You'll find no copay for primary care visits, preventive services, and many other services, such as home health and hearing exams. The plan also includes coverage for vision, dental, and home infusion services. This plan features specific copays for services like emergency care, specialist visits, and prescription hearing aids. You'll also have access to benefits like hearing and vision care, with set copays and coverage limits, as well as coverage for durable medical equipment and diagnostic services. The plan also covers skilled nursing facility and cardiac rehabilitation services with prior authorization.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $495 copay for days 1-5, and no copay for days 6-90, with additional days 91-999 having no copay. For Inpatient Hospital Psychiatric, you will pay a $495 copay for days 1-4, and no copay for days 5-90. Non-Medicare-covered stay and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $495, observation services with a $495 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, and outpatient blood services with no copay. Prior authorization and a doctor referral are required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered under the AARP Medicare Advantage CareFlex from UHC TX-45 (HMO-POS) plan, with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the AARP Medicare Advantage CareFlex from UHC TX-45 (HMO-POS) plan. Ground and Air Ambulance Services have a $275 copay, and there is no coinsurance; however, Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $125 copay, and Urgently Needed Services has a copay of $0-$55; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a copay of $0-$45 with no coinsurance, and require prior authorization and a doctor's referral. Physician Specialist Services have a copay of $0-$50 with no coinsurance, and also require prior authorization and a doctor's referral. Mental Health Specialty Services, including individual sessions with a $0-$25 copay and group sessions with a $15 copay, require prior authorization and a doctor's referral. Podiatry Services have a $45 copay for Medicare-covered services and routine foot care, and require prior authorization and a doctor's referral. Other Health Care Professional Services have a $0-$50 copay and require prior authorization and a doctor's referral. Psychiatric Services, including individual sessions with a $0-$25 copay and group sessions with a $15 copay, require prior authorization and a doctor's referral. Physical Therapy and Speech-Language Pathology Services have a $0-$50 copay, with no coinsurance, and require prior authorization and a doctor's referral. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have no copay and require prior authorization.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with no copay, and an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, and Home and Bathroom Safety Devices and Modifications, are covered with a $0 copay. Other services, such as Health Education, In-Home Safety Assessment, and others, are not covered.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have no copay, and routine hearing exams are covered for one visit per year. Prescription hearing aids have a copay between $199 and $1249 for all types of prescription hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids have a copay between $99 and $829 for 2 hearing aids every year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and eyewear has a $250 combined maximum benefit every two years, with no copay for contact lenses and eyeglass frames, and a copay of $0-$153 for eyeglass lenses. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance, and other services like Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) with no copay. Other services, such as Implant Services and Orthodontics, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the AARP Medicare Advantage CareFlex from UHC TX-45 (HMO-POS) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 50% coinsurance, Prosthetics/Medical Supplies with 50% coinsurance, and Diabetic Equipment with a copay for Medicare-covered supplies and therapeutic shoes or inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $45 copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $250, Therapeutic Radiological Services with at least 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage CareFlex from UHC TX-45 (HMO-POS) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and a Meal Benefit. OTC items have no copay, and the Meal Benefit also has no copay, but requires prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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