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UHC The Villages Medicare Advantage FL-0004 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC The Villages Medicare Advantage FL-0004 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC The Villages Medicare Advantage FL-0004 (HMO-POS) in 2025, please refer to our full plan details page.
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Lake, Marion and Sumter Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC The Villages Medicare Advantage FL-0004 (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 The Villages Medicare Advantage FL-0004 (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 The Villages Medicare Advantage FL-0004 (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. Additionally, this plan comes with a Part B Premium reduction of $16.00. You must continue to pay paying your reduced 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 $2700.00 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 The Villages Medicare Advantage FL-0004 (HMO-POS) plan has a $175.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $0 copay for preferred generic drugs at a standard pharmacy. Standard generic drugs have a $47.00 copay, and preferred and standard brand drugs have a $100.00 copay. Non-preferred drugs have a 31% coinsurance.
Additional Benefits
The UHC The Villages Medicare Advantage FL-0004 (HMO-POS) plan provides comprehensive coverage with a variety of benefits. This plan offers inpatient hospital care with a copay, outpatient services with copays, and emergency services with copays. It also includes coverage for primary care, preventive services, hearing, vision, dental, and home health services, often with no copay. Additional benefits include ambulance services, partial hospitalization, and skilled nursing facility care with copays. The plan also provides coverage for home infusion, dialysis, medical equipment, diagnostic and radiological services, and cardiac rehabilitation services, along with over-the-counter items and meal benefits. However, some services like certain therapies, home-based support, and specific dental procedures may have cost-sharing or are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a $175 copay for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a copay ranging from $0 to $175, and observation services with a $175 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services, including individual and group sessions, also have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by UHC The Villages Medicare Advantage FL-0004 (HMO-POS), with a $225 copay for both ground and air ambulance services, and no coinsurance. 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 by UHC The Villages Medicare Advantage FL-0004 (HMO-POS). Emergency Services has a $125 copay, while Urgently Needed Services have a copay between $0 and $35; both have no coinsurance. Worldwide Emergency Services has a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, and no coinsurance.
Primary Care See details
The UHC The Villages Medicare Advantage FL-0004 (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy with a copay between $0 and $20. The plan also covers physician specialist services with a copay between $0 and $30, mental health specialty services and psychiatric services with no copay, podiatry services with a $30 copay, other health care professional services with a copay between $0 and $30, physical therapy and speech-language pathology services with a copay between $0 and $20, additional telehealth benefits with no copay, and opioid treatment program services with no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, in addition to an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Home and Bathroom Safety Devices and Modifications with no copay, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Other services such as 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 (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with no copay, and prescription hearing aids with a copay of $199-$1249, and OTC hearing aids with a copay of $99-$829; fitting/evaluation for hearing aids, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered. Routine hearing exams are limited to one per year, and prescription hearing aids are limited to two per year.
Vision Services See details
The UHC The Villages Medicare Advantage FL-0004 (HMO-POS) plan covers vision services, including routine eye exams with no copay. Eyewear benefits are also covered, with no copay for contact lenses and eyeglass frames, and a copay of $0-$153 for eyeglass lenses; this includes a combined maximum of $300 every two years. 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 dental services with a $2,500 maximum plan benefit. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. Restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no copay. Prosthodontics, removable and prosthodontics, fixed have 0%-50% coinsurance. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered under this plan. DME has a 20% coinsurance and requires prior authorization. Prosthetics and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and outpatient x-ray services, are covered. Diagnostic procedures/tests have a $10 copay, lab services have no copay, diagnostic radiological services have a copay up to $170, therapeutic radiological services have a copay up to $50, and outpatient x-ray services have a $5 copay.
Home Health Services See details
Home Health Services are covered by UHC The Villages Medicare Advantage FL-0004 (HMO-POS) 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 covered, but the specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services offered by UHC The Villages Medicare Advantage FL-0004 (HMO-POS) include over-the-counter (OTC) items and meal benefits with no copay, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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