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AARP Medicare Advantage from UHC TX-0007 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC TX-0007 (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-0007 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC TX-0007 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in East Texas. 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-0007 (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-0007 (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-0007 (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 $520.00 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-0007 (PPO) plan features an annual drug deductible of $520. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through mail order. Tier 2 generic drugs cost a $12 copay for a 1-month supply at standard pharmacies, but members can receive a 3-month supply with no copay through preferred mail order. For higher-tier medications, costs are based on coinsurance percentages rather than flat copays. Tier 3 preferred brand drugs require a 16% coinsurance, while Tier 4 non-preferred drugs carry a 42% coinsurance for standard pharmacies and mail order. Specialty Tier 5 medications are subject to a 27% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC TX-0007 (PPO) plan offers robust coverage with many essential services featuring no copay and no coinsurance, including primary care visits, routine physicals, and annual vision and hearing exams. For hospital care, members pay a $415 daily copay for the first five days of an inpatient stay, while outpatient hospital services range from no copay up to $415. Emergency room visits carry a $130 copay, which is waived upon admission, and ambulance services require a $150 copay. Specialist visits require a copay ranging from $0 to $60, while routine dental cleanings and home health services are available with no copay or coinsurance. However, some specialized medical needs, such as durable medical equipment, dialysis, and Medicare Part B drugs, require a 20% coinsurance. Additionally, the plan covers over-the-counter items and select hearing aids with set copays, helping to keep overall healthcare costs predictable.
Inpatient Hospital See details
Inpatient Hospital coverage under the AARP Medicare Advantage from UHC TX-0007 (PPO) plan features no coinsurance, with a $415 copay per day for days 1 through 5 and no copay for days 6 through 90 per stay. While unlimited additional acute care days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by AARP Medicare Advantage from UHC TX-0007 (PPO) feature no coinsurance, with no copays required for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $415 ($415 per day for observation services), while outpatient substance abuse services carry a copay of $0 to $25 for individual sessions and $15 for group sessions.
Partial Hospitalization See details
AARP Medicare Advantage from UHC TX-0007 (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC TX-0007 (PPO) covers ground and air ambulance services with a $150 copay and no coinsurance, though prior authorization is required. Routine transportation services, including trips to plan-approved or any health-related locations, are not covered.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage from UHC TX-0007 (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay ranging from no copay to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
AARP Medicare Advantage from UHC TX-0007 (PPO) provides primary care physician visits, telehealth, and opioid treatment services with no copay and no coinsurance, while chiropractic services are not covered. Other covered services have no coinsurance, with copays ranging from $10 for physical, occupational, and speech therapies to $0-$60 for specialists, and up to $45 for podiatry and $25 for mental health sessions.
Preventive Services See details
AARP Medicare Advantage from UHC TX-0007 (PPO) covers annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. Additional preventive services are partially covered, offering fitness benefits and home safety devices with no copay and no coinsurance, while health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
AARP Medicare Advantage from UHC TX-0007 (PPO) covers hearing services with no coinsurance, including one annual routine hearing exam with no copay, though fitting and evaluation exams are not covered. Up to two OTC hearing aids are covered yearly with a $199 to $829 copay, and up to two prescription hearing aids are covered with a $199 to $1,249 copay, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services under the AARP Medicare Advantage from UHC TX-0007 (PPO) plan are partially covered with no coinsurance and no copay for one routine yearly eye exam, contact lenses, and eyeglass frames, though eyeglass lenses require a copay of $0.00 to $153.00. A combined eyewear maximum benefit of $150 is allowed every two years, while other eye exams, combined eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
AARP Medicare Advantage from UHC TX-0007 (PPO) provides partially covered dental services, featuring Medicare-covered dental care with no copay and a 20% coinsurance, alongside preventive services like exams and cleanings with no copay and no coinsurance. However, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC TX-0007 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B drugs, including chemotherapy, radiation, and other drugs, carry no coinsurance to 20% coinsurance, while insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
AARP Medicare Advantage from UHC TX-0007 (PPO) covers Dialysis Services with no copay and 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
AARP Medicare Advantage from UHC TX-0007 (PPO) covers durable medical equipment, medical supplies, and prosthetic devices with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay from specified manufacturers, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC TX-0007 (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services feature no copay, diagnostic procedures and outpatient X-rays carry a $5 copay, and diagnostic and therapeutic radiological services have copays starting at no copay and $30, respectively.
Home Health Services See details
Home Health Services are covered under the AARP Medicare Advantage from UHC TX-0007 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the AARP Medicare Advantage from UHC TX-0007 (PPO) plan, despite having no copayment and no coinsurance. Specifically, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are all not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC TX-0007 (PPO) covers skilled nursing facility (SNF) services with no coinsurance, though prior authorization is required and admission does not require a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
AARP Medicare Advantage from UHC TX-0007 (PPO) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, though prior authorization is required for meals. Acupuncture is not covered under this plan.
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