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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 2026, 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 4.5 out of 5 stars in 2026.
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 $270.00 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 features an annual drug deductible of $270. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when using standard pharmacies or standard mail order services. This zero-dollar coverage applies to both one-month and three-month supplies, helping you save on essential daily prescriptions. For brand-name and specialty medications, your costs will be based on a coinsurance percentage. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs carry a 39% coinsurance and Tier 5 specialty drugs carry a 30% coinsurance. These coinsurance rates apply to standard pharmacy and standard mail order fills, ensuring predictable costs for your higher-tier prescription needs.
Additional Benefits
The UHC The Villages Medicare Advantage FL-0004 (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits, preventive screenings, and home health services. Inpatient hospital stays require a $175 copay per stay with no coinsurance, while emergency room visits have a $150 copay that is waived if you are admitted. Outpatient hospital services and specialist visits are also highly affordable, with specialist copays ranging from no copay to $40 and no coinsurance. For routine care, members enjoy no copay for annual vision and hearing exams, alongside preventive dental care covered with no copay up to a $4,000 annual maximum. Skilled nursing facility stays feature no copay for the first 20 days, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Diagnostic services like lab tests and diagnostic radiology are also covered with no copay, helping to keep your ongoing healthcare expenses manageable.
Inpatient Hospital See details
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) covers inpatient acute and psychiatric hospital stays with a $175 copay per stay and no coinsurance, subject to prior authorization. Unlimited additional days for acute stays are covered with no copay, but additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center services, outpatient substance abuse sessions, and outpatient blood services. Outpatient hospital services have no coinsurance and a copay ranging from $0 to $175, while outpatient observation services require no coinsurance and a $175 daily copay.
Partial Hospitalization See details
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) covers ground and air ambulance services with a $100 copay and no coinsurance, subject to prior authorization. Routine transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by UHC The Villages Medicare Advantage FL-0004 (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 feature a copay ranging from no copay to $65 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) covers primary care, telehealth, psychiatric, and mental health services with no copay and no coinsurance. Specialist visits range from a $0 to $40 copay, therapy services require a $5 copay, and podiatry has a $40 copay, all with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by UHC The Villages Medicare Advantage FL-0004 (HMO-POS) with no copay and no coinsurance for annual physicals, fitness benefits, kidney education, and screenings. However, the benefit is partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by UHC The Villages Medicare Advantage FL-0004 (HMO-POS), which provides one annual routine hearing exam with no copay and no coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids (with copays ranging from $199.00 to $1,249.00) and OTC hearing aids (with copays ranging from $199.00 to $829.00) are covered with no coinsurance, but inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by UHC The Villages Medicare Advantage FL-0004 (HMO-POS) with no coinsurance, featuring no copay for annual routine eye exams, contact lenses, and eyeglass frames. Covered eyeglass lenses have a copay of $0 to $153 with a combined eyewear maximum of $300 every two years, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by UHC The Villages Medicare Advantage FL-0004 (HMO-POS), with implant services and orthodontics not covered. Preventive care is offered with no copay and no coinsurance up to a $4,000 annual maximum, while Medicare-covered dental services have no copay and a 20% coinsurance, and covered comprehensive services have no copay and a 50% coinsurance.
Home Infusion bundled Services See details
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs require a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for most items.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC The Villages Medicare Advantage FL-0004 (HMO-POS) with no coinsurance, although prior authorization is required. There is no copay for lab services and diagnostic radiology, a $5 copay for diagnostic procedures and outpatient X-rays, and a minimum $10 copay for therapeutic radiology.
Home Health Services See details
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under UHC The Villages Medicare Advantage FL-0004 (HMO-POS) with no copay and no coinsurance, though in practice only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered, and prior authorization is required.
Skilled Nursing Facility (SNF) See details
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
UHC The Villages Medicare Advantage FL-0004 (HMO-POS) partially covers other services, offering a meal benefit for chronic illnesses with no copay and no coinsurance, though prior authorization is required. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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