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AARP Medicare Advantage from UHC TX-0003 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC TX-0003 (PPO). 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-0003 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage from UHC TX-0003 (PPO) is a PPO 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 out of 5 stars in 2025.
It's important to know that AARP Medicare Advantage from UHC TX-0003 (PPO) 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-0003 (PPO).
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-0003 (PPO), 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 $420.00 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 combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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-0003 (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $420. During the initial coverage phase, after you pay your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For standard pharmacies, you will pay a $14 copay for tier 1 drugs, a $47 copay for tier 2 drugs, and a $100 copay for tier 3 drugs. For tier 4 drugs, you will pay 28% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The AARP Medicare Advantage from UHC TX-0003 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $300 copay for the first six days, with no copay thereafter. Outpatient services have copays ranging from $0 to $300, and emergency services have a $125 copay. The plan covers primary care and many specialist services with no copay or a copay between $20 and $40. Preventive services, including an annual physical, have no copay. The plan also includes dental, vision, and hearing benefits, with specific copays and coverage limits.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both with a $300 copay for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute have no copay, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $300, observation services with a $300 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 is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AARP Medicare Advantage from UHC TX-0003 (PPO) plan. Ground and Air Ambulance Services have a $290 copay, and there is 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 the AARP Medicare Advantage from UHC TX-0003 (PPO) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a copay between $0 and $55 with no coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The AARP Medicare Advantage from UHC TX-0003 (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a copay between $0 and $40, and Physician Specialist Services with a copay between $0 and $40. The plan also covers Mental Health Specialty Services, Podiatry Services with a $40 copay, Other Health Care Professional services with a copay between $0 and $40, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services with a copay between $0 and $40, 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 an annual physical exam with no copay, and additional preventive services, kidney disease education services, and other preventive services. Services like Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered. Other services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have no copay for routine hearing exams, which are limited to one exam per year. Prescription hearing aids have a copay between $199 and $1249 for all types, with a limit of two per year. OTC hearing aids have a copay between $99 and $829 for two hearing aids per year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear has a combined maximum benefit of $300 every two years, and contact lenses, eyeglass lenses, and eyeglass frames are covered with no copay, but eyeglass lenses have a copay of $0-$153. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include 20% coinsurance for Medicare Dental Services after prior authorization, and no copay for oral exams (2 per year), dental x-rays (limited), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), and other preventive dental services (limited). Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. You will pay a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0-20% for all drugs.
Dialysis Services See details
Dialysis Services are covered by the AARP Medicare Advantage from UHC TX-0003 (PPO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies with a 20% coinsurance and no copay. Diabetic Equipment is also covered, with a coinsurance for Medicare-covered Diabetic Supplies, a copay for Medicare-covered Diabetic Therapeutic Shoes or Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a $50 copay, and lab services with no copay. Radiological Services are covered, with a copay for diagnostic services (up to $180) and outpatient x-ray services ($25), and a coinsurance of at least 20% for therapeutic services.
Home Health Services See details
Home Health Services are covered by AARP Medicare Advantage from UHC TX-0003 (PPO) 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 not the Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits. Over-the-Counter (OTC) Items have no copay, while Meal Benefits also have no copay and require prior authorization; however, 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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