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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 2025, 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 4 out of 5 stars in 2025.
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 $14000.00 (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 $14000.00 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:
Sign up for AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO)
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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 a range of benefits, including coverage for inpatient and outpatient services, with varying copays. Many services have no copay, such as primary care, preventive services, hearing exams, eye exams, and dental services. This plan also covers ambulance and transportation services, with copays for ground and air ambulance services, and offers transportation to plan-approved locations with no copay. Additionally, it covers home health services, diagnostic services, and medical equipment, with specific copays or coinsurance amounts depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $395 for days 1-6 and days 1-5, respectively, and no copay for the remaining days. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay of $0-$395, observation services with a copay of $395, and Ambulatory Surgical Center (ASC) services with no copay. The plan also covers outpatient substance abuse services with a copay of $0-$25 for individual sessions and $15 for group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) plan, and requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services, each with a $275 copay. Transportation Services to plan-approved health-related locations are also covered with no copay for up to 12 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $110 copay, and Urgently Needed Services has a copay between $0 and $45; all other services have no copay and no coinsurance.
Primary Care See details
The AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay, but routine chiropractic care is not covered. Occupational therapy services have a copay between $0 and $35, while physician specialist services have a copay between $0 and $55. Mental health services (individual sessions) have a copay between $0 and $25, and group sessions have a $15 copay. Podiatry services and routine foot care have a $45 copay. Other health care professional services have a copay between $0 and $55. Psychiatric services (individual sessions) have a copay between $0 and $25, and group sessions have a $15 copay. Physical therapy and speech-language pathology services have a copay between $0 and $50. Additional telehealth benefits have no copay, and opioid treatment program services have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services like fitness benefits, home and bathroom safety devices and modifications, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with no copay, while prescription hearing aids have a copay between $199 and $1249 for all types, and over-the-counter hearing aids have a copay between $99 and $829. Fitting/evaluation for hearing aids, 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 include eye exams with no copay and routine eye exams with no copay, and eyewear. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames and upgrades, all of which are not covered.
Dental Services See details
Dental services are covered, including Medicare dental services with 20% coinsurance. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, and other preventive dental services have no copay. Restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no copay. Prosthodontics (removable and fixed) have a coinsurance between 0% and 50%. However, implant services 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. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical equipment benefits are covered by the AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) plan. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies have no copay, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a $50 copay, lab services with no copay, diagnostic radiological services with a maximum copay of $250, therapeutic radiological services with a 20% coinsurance, and outpatient X-ray services with a $25 copay.
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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) plan covers over-the-counter items with no copay, and also offers a meal benefit with no copay and requires prior authorization. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and many other services are not covered.
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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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