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AARP Medicare Advantage from UHC SI-0001 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC SI-0001 (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 SI-0001 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage from UHC SI-0001 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Sioux Falls 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 SI-0001 (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 SI-0001 (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 SI-0001 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.00. 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 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 SI-0001 (PPO) plan has a $495 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, in the initial coverage phase, you will pay a $12 copay for a standard generic drug at a standard pharmacy. For non-preferred drugs, you will pay 27% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The AARP Medicare Advantage from UHC SI-0001 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services can have copays up to $465. Emergency services have a $125 copay, and primary care visits have no copay. Preventive services, such as annual exams, come with no copay, and vision services like eye exams also have no copay. Dental services include no copay for oral exams, X-rays, and cleanings. The plan also covers home health services with no copay, and offers additional benefits like over-the-counter items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization; for days 1-5, the copay is $465, and then there is no copay for days 6-90. Additional days for Inpatient Hospital-Acute have no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, 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 $465, and observation services with a $465 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and outpatient substance abuse services have no copay for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the AARP Medicare Advantage from UHC SI-0001 (PPO) plan, but requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $290 copay and no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, including urgently needed services and worldwide emergency services. Emergency services have a $125 copay, urgently needed services have a copay between $0 and $55, and worldwide emergency services have a copay.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Additional Telehealth Benefits, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, and Opioid Treatment Program Services are covered with a copay of $0, while Chiropractic Services have a $20 copay, and Physician Specialist Services have a copay between $0 and $40. Podiatry Services and Other Health Care Professional have a copay between $40 and $0, and Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $25. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional services such as fitness benefits, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Other services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing services include hearing exams and OTC hearing aids, both with a copay. Routine hearing exams have no copay, while prescription hearing aids have a copay between $199 and $1249, and OTC hearing aids have a copay between $99 and $829. Fitting/evaluation for hearing aids, and prescription hearing aids (inner ear, outer ear, and over the ear) are not covered.
Vision Services See details
The AARP Medicare Advantage from UHC SI-0001 (PPO) plan covers vision services, including eye exams with no copay, and eyewear. Eyewear coverage includes contact lenses with no copay, and eyeglass lenses with a copay between $0 and $153, and eyeglass frames with no copay. This plan has a combined maximum benefit of $300 for all eyewear every two years, and does not cover eyeglasses (lenses and frames) or upgrades.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, Oral Exams with no copay, Dental X-Rays with no copay, Prophylaxis (Cleaning) with no copay, Fluoride Treatment with no copay, and Other Preventive Dental Services with no copay. 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 and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the AARP Medicare Advantage from UHC SI-0001 (PPO) plan, but require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
The AARP Medicare Advantage from UHC SI-0001 (PPO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance, and Prosthetic Devices, Medicare-covered Prosthetic Devices, and Medical Supplies with a 20% coinsurance. Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay of $35, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $200, Therapeutic Radiological Services have a copay of at most $80, and Outpatient X-Ray Services have a copay of $25.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage from UHC SI-0001 (PPO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the AARP Medicare Advantage from UHC SI-0001 (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered stays are not covered.
Other Services See details
The AARP Medicare Advantage from UHC SI-0001 (PPO) plan covers Over-the-Counter (OTC) Items and Meal Benefits, but Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered. Over-the-Counter (OTC) Items have no copay, and Meal Benefits also have no copay. The plan does not cover 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, or Self-Directed Personal Assistance Services.
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