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UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO) in 2025, please refer to our full plan details page.
UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Wyoming. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that UHC Medicare Advantage Patriot No Rx WY-MA01 (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 UHC Medicare Advantage Patriot No Rx WY-MA01 (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 UHC Medicare Advantage Patriot No Rx WY-MA01 (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 $65.00. 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 $6700.00 (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 $6700.00 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 UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO).
Additional Benefits
The UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services often have copays between $0 and $425. Emergency and urgent care services have copays, and ambulance services have a $290 copay. This plan includes no copay for primary care, preventive services, routine hearing and vision exams, and many dental services. You will also find that home health services, OTC items, and many other services have no copay. However, some services like skilled nursing facilities and home infusion bundled services may have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a $425 copay for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a $425 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $425, observation services with a $425 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO) plan, with no coinsurance for all ambulance services. Ground and Air Ambulance Services have a copay of $290. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO) plan. Emergency Services has a $125 copay with no coinsurance, Urgently Needed Services have a copay between $0 and $55 with no coinsurance, and Worldwide Emergency Services have no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $20 copay. Occupational Therapy Services have a copay between $0 and $45. Physician Specialist Services have a copay between $0 and $50. Individual Sessions for Mental Health Specialty Services have a copay between $0 and $25, while 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 $50. Individual Sessions for Psychiatric Services have a copay between $0 and $25, while Group Sessions have a $15 copay. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $45. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have no copay.
Preventive Services See details
The UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, kidney disease education services, and other preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay, and are limited to one per year. Prescription hearing aids have a copay between $199 and $1249, and are limited to 2 per year. OTC hearing aids have a copay between $99 and $829, and are limited to 2 per year. Fitting/Evaluation for Hearing Aid, 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 includes coverage for eye exams with no copay, routine eye exams with no copay, contact lenses with no copay, eyeglass lenses with a copay between $0 and $153, and eyeglass frames with no copay. Eyeglass frames are limited to one every two years, and there is a combined maximum benefit of $200 for all eyewear every two years.
Dental Services See details
The UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO) plan covers a variety of dental services. Medicare Dental Services have a 20% coinsurance, while other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, and oral and maxillofacial surgery with no copay and a 0-50% coinsurance depending on the service; 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 with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, while 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 $45 copay, and lab services with no copay. Radiological Services include coverage for diagnostic radiological services with a copay up to $250, therapeutic radiological services with up to 20% coinsurance, and outpatient X-ray services with a $25 copay.
Home Health Services See details
Home Health Services are covered by the UHC Medicare Advantage Patriot No Rx WY-MA01 (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 not covered by the UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO) plan. Prior authorization is required for coverage, but all listed services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the UHC Medicare Advantage Patriot No Rx WY-MA01 (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 are not covered.
Other Services See details
The UHC Medicare Advantage Patriot No Rx WY-MA01 (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a meal benefit with no copay and prior authorization required. Acupuncture, 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 are not covered.
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