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UHC Medicare Advantage VT-001A (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Medicare Advantage VT-001A (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 VT-001A (PPO) in 2025, please refer to our full plan details page.
UHC Medicare Advantage VT-001A (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of Vermont. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Medicare Advantage VT-001A (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 UHC Medicare Advantage VT-001A (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 VT-001A (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $52.50. 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 $590.00 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 $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:
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Drug Coverage
The UHC Medicare Advantage VT-001A (PPO) plan has a $590 deductible for prescription drugs. After meeting your deductible, you will pay the costs associated with each drug tier until your total drug costs reach $2,000. Once your yearly out-of-pocket drug costs reach $2,000, you will enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, with a monthly premium of $52.50.
Additional Benefits
The UHC Medicare Advantage VT-001A (PPO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $2,000 copay per admission, and emergency services have a $105 copay. Many services, including primary care, preventive services, vision, and dental, have no copay, while others like ambulance, outpatient services, and medical equipment have coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $2,000 copay per admission or stay. For Additional Days for Inpatient Hospital-Acute, there is no copay for days 91-999.
Outpatient Services See details
The UHC Medicare Advantage VT-001A (PPO) plan covers outpatient services including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a coinsurance between 0% and 20%, observation services have a 20% coinsurance, and ASC services have a coinsurance between 0% and 20%. Individual outpatient substance abuse sessions have a coinsurance between 0% and 20%, while group sessions have a 20% coinsurance. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by UHC Medicare Advantage VT-001A (PPO) with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered under the UHC Medicare Advantage VT-001A (PPO) plan, with a $105 copay. Urgently Needed Services have a copay between $0 and $30, and Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, all have no copay.
Primary Care See details
The UHC Medicare Advantage VT-001A (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services and physician specialist services have a coinsurance of 0% to 20%, while chiropractic services have a 20% coinsurance and requires prior authorization. Occupational therapy services, mental health specialty services, psychiatric services, and other health care professional services have a coinsurance of 0% to 20%. Additional telehealth benefits and opioid treatment program services have no copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, and other services like glaucoma screenings and diabetes self-management training with no copay. Additional preventive services and kidney disease education services are covered, but you should check with the plan about copays. The plan does not cover services such as health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Hearing services include coverage for hearing exams with a coinsurance of at most 20% for routine hearing exams, but fitting/evaluation for hearing aids is not covered. Prescription hearing aids are covered, with a maximum plan benefit of $1500 per year, and OTC hearing aids are covered with no copay.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams, including routine eye exams, and eyewear, including contact lenses, eyeglass lenses and eyeglass frames, have no copay; however, eyeglass lenses and eyeglass frames are limited to one per year, and there is a $300 combined maximum plan benefit for all eyewear. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Medicare Advantage VT-001A (PPO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay, but with varying limitations on the number of visits and periodicity. Medicare Dental Services are covered with a 20% coinsurance, and Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery are covered with no copay. Implant and Orthodontic services 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. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%. The other drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Medicare Advantage VT-001A (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medicare-covered 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 are covered. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the UHC Medicare Advantage VT-001A (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 the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and the plan charges the Medicare-defined cost share for tier 1.
Other Services See details
The UHC Medicare Advantage VT-001A (PPO) plan covers Over-the-Counter (OTC) items and Meal Benefits, with no copay. 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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