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AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage Patriot No Rx TX-MA04 (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 Patriot No Rx TX-MA04 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in 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 Patriot No Rx TX-MA04 (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about AARP Medicare Advantage Patriot No Rx TX-MA04 (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 Patriot No Rx TX-MA04 (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. Additionally, this plan comes with a Part B Premium reduction of $75.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO).
Additional Benefits
The AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) plan offers robust coverage with no copay and no coinsurance for primary care, telehealth visits, and preventive services. For specialist visits, members can expect a copay ranging from $0 to $60, while emergency room visits carry a $130 copay that is waived if admitted. Inpatient hospital stays require a $455 copay per day for the first six days, followed by no copay for additional days, all with no coinsurance. Routine dental cleanings, annual eye exams, and routine hearing exams are fully covered with no copay and no coinsurance. For other medical needs, diabetic supplies and home health services are available with no copay, while durable medical equipment and dialysis services require a 20% coinsurance. Prescription hearing aids are also covered with copays ranging from $199 to $1,249 with no coinsurance.
Inpatient Hospital See details
AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) covers inpatient acute hospital stays with no coinsurance and a $455 copay for days 1 to 6, with no copay for days 7 and beyond. Inpatient psychiatric stays are covered with no coinsurance and a $455 copay for days 1 to 5, though the overall benefit is partially covered since upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) are covered with no coinsurance, including no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $455 (with a $455 daily copay for observation services), and outpatient substance abuse services require a copay of $0 to $25, with prior authorization required for most services.
Partial Hospitalization See details
AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) covers ground and air ambulance services with a $150 copay per service and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Emergency services are covered under the AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) plan with a $130 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services carry a copay of $0 to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are provided with no copay and no coinsurance.
Primary Care See details
AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $60 copay and no coinsurance. Physical, occupational, and speech therapies have a $30 copay, mental health and psychiatric sessions range from a $0 to $25 copay, and routine podiatry is covered for up to 6 visits annually with a $45 copay, all with no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) with no copay and no coinsurance for covered services like annual exams, fitness benefits, and glaucoma screenings. However, several supplemental options are not covered, including health education, in-home safety assessments, personal emergency response systems, weight management, medical nutrition therapy, and alternative therapies.
Hearing Services See details
Hearing Services are partially covered by the AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) plan, which offers routine hearing exams with no copay and no coinsurance, but excludes fitting and evaluation services. Prescription hearing aids have a copay of $199.00 to $1,249.00 and OTC hearing aids have a copay of $199.00 to $829.00, both with no coinsurance, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) partially covers vision services, offering one routine eye exam per year with no copay, no coinsurance, and no deductible, though prior authorization is required. Other eye exams and all eyewear benefits, including contacts, eyeglasses, lenses, frames, and upgrades, are not covered.
Dental Services See details
AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) partially covers dental services, providing Medicare-covered dental care with no copay and a 20% coinsurance. Preventive services like oral exams, cleanings, fluoride, and x-rays are covered with no copay and no coinsurance, but restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) with no copay and no coinsurance. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO), featuring no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Outpatient X-rays and diagnostic tests carry a $5 copay, therapeutic radiological services require a $60 copay, and there is no copay for lab services or diagnostic radiology.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) covers cardiac rehabilitation services with no copay and no coinsurance, subject to prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no prior three-day hospital stay but subject to prior authorization. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) partially covers other services, offering a meal benefit for chronic illnesses with no copay and no coinsurance, subject to prior authorization. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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