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AARP Medicare Advantage Patriot No Rx TX-MA05 (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-MA05 (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-MA05 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage Patriot No Rx TX-MA05 (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-MA05 (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-MA05 (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-MA05 (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 $100.00. 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-MA05 (PPO).
Additional Benefits
The AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) plan offers cost-effective coverage with many essential services featuring no copay and no coinsurance. You will pay no copay for primary care visits, routine dental cleanings, annual physicals, and routine vision and hearing exams. For specialized care, specialist visits require a copay of up to $65, while inpatient hospital stays require a $550 copay for the first few days before transitioning to no copay. Additionally, emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Medical equipment, dialysis, and Medicare Part B drugs generally require a 20% coinsurance with no copay. While the plan provides strong coverage for basic and preventive care, supplemental benefits like comprehensive dental services, eyewear, and acupuncture are not covered.
Inpatient Hospital See details
Inpatient Hospital care is partially covered by the AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) plan with no coinsurance, requiring a $550 copay for days 1 through 5 of acute stays and days 1 through 4 of psychiatric stays, and no copay for subsequent days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services carry a copay of $0 to $550 (including a $550 daily copay for observation services), while outpatient substance abuse services range from no copay to $25 depending on the session type.
Partial Hospitalization See details
Partial hospitalization is covered under the AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) plan with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO), which features a $290 copay and no coinsurance for both ground and air ambulance services. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
AARP Medicare Advantage Patriot No Rx TX-MA05 (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 require a copay of $0 to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copays and no coinsurance.
Primary Care See details
AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $65 copay. Other services like physical therapy, occupational therapy, and mental health sessions have copays ranging from $0 to $65 and no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered under the AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) plan, with covered services such as annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, and fitness benefits having no copay and no coinsurance. However, several supplemental benefits are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and home-based palliative care.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) with no coinsurance or deductibles, featuring one routine hearing exam per year with no copay. Fitting and evaluation exams are not covered, and while prescription hearing aids (copay of $199.00 to $1,249.00) and OTC hearing aids (copay of $199.00 to $829.00) are covered up to two per year with no coinsurance, inner ear, outer ear, and over-the-ear prescription models are excluded.
Vision Services See details
Vision services are partially covered by AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO), which features one routine eye exam every year with no copay and no coinsurance, subject to prior authorization. Other eye exams and all eyewear options—including contact lenses, eyeglass lenses, frames, and upgrades—are not covered.
Dental Services See details
AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) dental services are partially covered, offering Medicare-covered dental care with no copay and 20% coinsurance, alongside preventive services like exams, cleanings, and X-rays with no copay and no coinsurance. Comprehensive services, including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics, are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, insulin, and other drugs are covered with no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
The AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) plan covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment benefits under the AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) plan cover durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copays and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) with no coinsurance, though prior authorization is required. Lab services and diagnostic radiological services feature no copay, while diagnostic procedures and tests cost a $5 copay, outpatient X-rays cost a $30 copay, and therapeutic radiological services require a $60 copay.
Home Health Services See details
AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) with no copay and no coinsurance, although prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, while days 21 through 100 require a $218 daily copay, with no coverage for additional days beyond the Medicare limit.
Other Services See details
AARP Medicare Advantage Patriot No Rx TX-MA05 (PPO) partially covers other services, providing a meal benefit for chronic illnesses with no copay and no coinsurance, though prior authorization is required. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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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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