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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 2026, 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 3.5 out of 5 stars in 2026.
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 $43.00. 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 $600.00 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 features an annual drug deductible of $600. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies, as well as for 3-month mail orders. Tier 2 generic medications cost a $12 copay for a 1-month supply at standard pharmacies, though members can get a 3-month supply with no copay when using preferred mail order. For brand-name and specialty medications, costs are based on coinsurance percentages. Tier 3 preferred brands require a 15% coinsurance for both 1-month and 3-month supplies through standard pharmacies and mail order. Tier 4 non-preferred drugs carry a 40% coinsurance, while Tier 5 specialty drugs require a 26% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC WA-0004 (PPO) plan provides comprehensive coverage for core medical needs, offering no copay and no coinsurance for primary care visits, routine annual physicals, and home health services. For inpatient hospital stays, there is no coinsurance, though members pay a $450 daily copay for days one through five and no copay for days six through 90. Emergency room visits require a $130 copay, which is waived if you are admitted within 24 hours, while urgent care services range from no copay to a $50 copay. Routine dental, vision, and hearing exams are covered with no copay, alongside a $250 biennial eyewear allowance, though comprehensive dental treatments are not covered. Specialist visits, outpatient therapies, and mental health sessions have copays ranging from no copay to $55, while diagnostic lab tests and diagnostic radiology require no copay. For specialized needs, dialysis, diabetic therapeutic shoes, and durable medical equipment carry a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital services under the AARP Medicare Advantage from UHC WA-0004 (PPO) plan are covered with no coinsurance, requiring a $450 copay per day for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because psychiatric additional days, room upgrades, and non-Medicare-covered stays are not covered, though unlimited additional acute care days are covered with no copay.
Outpatient Services See details
AARP Medicare Advantage from UHC WA-0004 (PPO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center visits and blood services. Outpatient hospital copays range from $0 to $450, observation services cost a $450 copay per day, and outpatient substance abuse sessions carry a copay of $0 to $25, with prior authorization required.
Partial Hospitalization See details
Partial hospitalization services are covered by the AARP Medicare Advantage from UHC WA-0004 (PPO) plan with a $55 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC WA-0004 (PPO) covers Medicare-approved ground and air ambulance services with a $240 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage from UHC WA-0004 (PPO) with a $130 copay, which is waived if you are admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services are covered with a copay ranging from $0 to $50 and 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 WA-0004 (PPO) offers primary care physician and telehealth visits with no copay and no coinsurance. Specialist visits, mental health, and therapy services are covered with copays ranging from $0 to $55 and no coinsurance, while chiropractic care is partially covered as other chiropractic services are not covered.
Preventive Services See details
AARP Medicare Advantage from UHC WA-0004 (PPO) covers preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, and select screenings. Additional preventive benefits are only partially covered, with a fitness benefit included, while services such as health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
AARP Medicare Advantage from UHC WA-0004 (PPO) offers partially covered hearing services with no coinsurance and no deductible. Routine hearing exams have no copay (limited to one per year), but fitting and evaluation exams, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered. Covered prescription hearing aids carry a $199 to $1,249 copay, and OTC hearing aids carry a $199 to $829 copay, with both limited to two devices per year.
Vision Services See details
Vision services are partially covered by the AARP Medicare Advantage from UHC WA-0004 (PPO) plan with no deductibles and no coinsurance, providing one routine eye exam per year at no copay. Eyewear is covered up to a $250 combined maximum every two years with no copay for contact lenses and frames, and a $0 to $153 copay for eyeglass lenses; however, other eye exams, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage from UHC WA-0004 (PPO) partially covers dental services, offering preventive care such as exams, cleanings, x-rays, and fluoride with no copay and no coinsurance, alongside Medicare-covered dental services with no copay and 20% coinsurance. However, comprehensive dental treatments including restorative, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by AARP Medicare Advantage from UHC WA-0004 (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
The AARP Medicare Advantage from UHC WA-0004 (PPO) plan covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
AARP Medicare Advantage from UHC WA-0004 (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for most of these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage from UHC WA-0004 (PPO) with no coinsurance, though prior authorization is required. There is no copay for lab services and diagnostic radiology, while diagnostic tests cost a $5 copay, outpatient X-rays cost a $25 copay, and therapeutic radiology services require a copay of at least $50.
Home Health Services See details
Home Health Services are covered by AARP Medicare Advantage from UHC WA-0004 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the AARP Medicare Advantage from UHC WA-0004 (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD services are all excluded. There is no copay or coinsurance for these non-covered services.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC WA-0004 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed before admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
AARP Medicare Advantage from UHC WA-0004 (PPO) provides partial coverage for other services, including acupuncture for a $10.00 copay and no coinsurance up to 12 treatments per year, and chronic illness meals with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this benefit.
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