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AARP Medicare Advantage from UHC WA-0004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC WA-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 WA-0004 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage from UHC WA-0004 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Washington. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that AARP Medicare Advantage from UHC WA-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 WA-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 WA-0004 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.00. 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 $495.00 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 WA-0004 (PPO) plan has an enhanced alternative drug benefit. The plan includes a $495 deductible for prescription drugs. During the initial coverage phase, after meeting your deductible, you will pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, standard generic drugs have a $12 copay, while preferred brand drugs have a $100 copay. You will enter the catastrophic coverage phase once your total drug costs reach $2000.
Additional Benefits
The AARP Medicare Advantage from UHC WA-0004 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $450 copay for days 1-5, and no copay for days 6-90, with outpatient services, primary care, and preventive services often having no copay. The plan covers hearing, vision, and dental services, with no copay for hearing exams, eye exams, and some dental services. Ambulance, emergency, and home health services are covered with copays and coinsurance. The plan also includes coverage for home infusion, dialysis, medical equipment, diagnostic and radiological services, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, there is a $450 copay, and days 6-90 have no copay; additional days for Inpatient Hospital-Acute have no copay for days 91-999.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a copay between $0 and $450, observation services with a $450 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for any services. Medicare-covered ground and air ambulance services each have a $290 copay, while other transportation services are not covered.
Emergency Services See details
Emergency Services are covered, with a $125 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $55, with no coinsurance. Worldwide Emergency Services are covered, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, each with no copay and no coinsurance.
Primary Care See details
The AARP Medicare Advantage from UHC WA-0004 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $10 copay, occupational therapy with a $0-$45 copay, and physician specialist services with a $0-$55 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, and opioid treatment program services are also covered, with copays varying based on the specific service. Additional telehealth benefits are covered with no copay.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Home and Bathroom Safety Devices and Modifications, and Alternative Therapies, are covered, with a copay for Alternative Therapies. Other services like Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
Hearing exams are covered with no copay, but fitting/evaluation for hearing aids are not covered. Prescription hearing aids are covered, with a copay between $199 and $1249, and OTC hearing aids are covered with a copay between $99 and $829.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, including routine eye exams. Eyewear has a combined maximum of $250 every two years, and includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services and no copay for Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the AARP Medicare Advantage from UHC WA-0004 (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while DME for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. 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 Diagnostic Procedures/Tests with a $50 copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $250, Therapeutic Radiological Services with 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 from UHC WA-0004 (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with prior authorization required. You will have no copay for days 1-20, and a $203 copay per day for days 21-100; there is no coinsurance.
Other Services See details
The "Other Services" benefit covers acupuncture with a $10 copay, over-the-counter items with no copay, and a meal benefit with no copay. The plan does not cover dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, case management (long term care), institution for mental disease services for individuals 65 or older, services in an intermediate care facility for individuals with intellectual disabilities, case management, tobacco cessation counseling for pregnant women, freestanding birth center services, respiratory care services, family planning services, nursing home services, home and community based services, personal care services, and self-directed personal assistance services.
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