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AARP Medicare Advantage from UHC TX-0004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC TX-0004 (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-0004 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC TX-0004 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Brownsville Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage from UHC TX-0004 (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-0004 (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-0004 (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 $600.00 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-0004 (PPO) plan has an annual prescription drug deductible of $600. Tier 1 preferred generic drugs feature no copay for standard pharmacy and mail order fills. Tier 2 generic drugs cost a $14 copay for a 1-month supply at standard pharmacies, but you can pay no copay for a 3-month supply using preferred mail order. For brand name and specialty medications, costs are based on coinsurance. Tier 3 preferred brand drugs require a 15% coinsurance for both standard pharmacy and mail order fills. Non-preferred drugs in Tier 4 require a 40% coinsurance, while Tier 5 specialty drugs have a 26% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC TX-0004 (PPO) plan offers comprehensive coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, preventive care, and routine home health services. Specialist visits and outpatient procedures require no coinsurance and feature low copays ranging from no copay to $55, while inpatient hospital stays require a $455 daily copay for the first several days. Emergency care is covered with a $130 copay that is waived upon admission, and worldwide emergency services are available with no copay and no coinsurance. For ancillary benefits, the plan provides routine hearing and vision exams with no copay, alongside coverage for eyewear and hearing aids. Preventive dental care features no copay and no coinsurance, while dialysis, durable medical equipment, and Medicare-covered dental services require a 20% coinsurance with no copay. Additionally, skilled nursing facility stays require no coinsurance and no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
AARP Medicare Advantage from UHC TX-0004 (PPO) offers partially covered inpatient hospital services with no coinsurance, requiring a $455 daily copay for days 1-6 of acute stays (no copay for days 7 and beyond) and a $455 daily copay for days 1-5 of psychiatric stays (no copay for days 6-90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC TX-0004 (PPO) covers outpatient services with no coinsurance, although prior authorization is required for most services. Patients pay no copay for ambulatory surgical center and outpatient blood services, while outpatient hospital copays range from $0 to $455, observation services cost $455 per day, and outpatient substance abuse sessions require copays between $0 and $25.
Partial Hospitalization See details
Partial hospitalization is covered by the AARP Medicare Advantage from UHC TX-0004 (PPO) plan with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC TX-0004 (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required and the copay is not waived upon hospital admission. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
AARP Medicare Advantage from UHC TX-0004 (PPO) covers emergency services with a $130 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 $0 to $50 with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
AARP Medicare Advantage from UHC TX-0004 (PPO) covers primary care visits, telehealth, and opioid treatment with no copay and no coinsurance, while chiropractic services are not covered. Other covered services, including specialists, mental health, podiatry, and physical therapy, require no coinsurance and have copays ranging from $0 to $55.
Preventive Services See details
Preventive Services are partially covered by AARP Medicare Advantage from UHC TX-0004 (PPO) with no copays and no coinsurance for covered benefits like annual physicals, fitness programs, and glaucoma screenings. However, several supplemental services are not covered, including health education, personal emergency response systems, medical nutrition therapy, weight management programs, and in-home safety assessments.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC TX-0004 (PPO) with no deductible and no coinsurance. Routine hearing exams are covered once yearly with no copay, but fitting and evaluation services are not covered. Up to two OTC hearing aids (with a $199 to $829 copay) and two prescription hearing aids (with a $199 to $1,249 copay) are covered annually, though inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by AARP Medicare Advantage from UHC TX-0004 (PPO) with no deductible, no coinsurance, and no copay for routine yearly eye exams and select eyewear. Covered eyewear includes contact lenses and eyeglass frames at no copay, and eyeglass lenses with a $0 to $153 copay (up to a $150 allowance every two years), while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage from UHC TX-0004 (PPO) partially covers dental services, providing Medicare-covered dental with no copay and 20% coinsurance, and preventive services like exams and cleanings with no copay and no coinsurance. Comprehensive dental services, including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics, are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC TX-0004 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance up to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage from UHC TX-0004 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
AARP Medicare Advantage from UHC TX-0004 (PPO) covers durable medical equipment, medical supplies, and prosthetic devices with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts have a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage from UHC TX-0004 (PPO) with no coinsurance, though prior authorization is required. Lab services and diagnostic radiological services have no copay, while diagnostic procedures cost a $10 copay, outpatient X-rays cost a $25 copay, and therapeutic radiological services require a minimum copay of $60.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage from UHC TX-0004 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
AARP Medicare Advantage from UHC TX-0004 (PPO) technically covers Cardiac Rehabilitation Services with no copay and no coinsurance, but in practice only some services are covered as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered. Prior authorization is required for any covered services.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC TX-0004 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by AARP Medicare Advantage from UHC TX-0004 (PPO), offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires prior authorization.
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