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AARP Medicare Advantage from UHC WA-12 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC WA-12 (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-12 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC WA-12 (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 4.5 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage from UHC WA-12 (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-12 (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-12 (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.
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-12 (PPO) plan features a $600 annual prescription drug deductible. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through mail-order services. Tier 2 generic drugs cost a $12 copay for a 1-month supply at standard pharmacies, but they feature no copay for a 3-month supply when filled through preferred mail order. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 15% coinsurance for both retail and mail-order prescriptions. Tier 4 non-preferred drugs carry a 38% coinsurance, while Tier 5 specialty drugs require a 26% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC WA-12 (PPO) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care, telehealth, and preventive services, while specialist visits require a copay of $0 to $60. For hospital stays, there is no coinsurance, though inpatient acute care requires a $550 daily copay for the first five days. Emergency services carry a $130 copay, which is waived if admitted, and urgent care ranges from no copay up to $50. Routine dental, vision, and hearing exams are covered with no copay, though specialized treatments like Medicare-covered dental and durable medical equipment require a 20% coinsurance. Prescription hearing aids require a copay of $199 to $1,249, while eyewear features a $300 combined limit every two years with no copay for contacts and frames. Skilled nursing facility care features no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
AARP Medicare Advantage from UHC WA-12 (PPO) covers inpatient hospital services with no coinsurance, featuring a $550 copay for days 1 to 5 of acute stays (no copay for days 6 and beyond) and a $550 copay for days 1 to 4 of psychiatric stays (no copay for days 5 to 90). This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
AARP Medicare Advantage from UHC WA-12 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $550 ($550 per day for observation services), and outpatient substance abuse sessions carry a copay of $0 to $25, with prior authorization required for most services.
Partial Hospitalization See details
AARP Medicare Advantage from UHC WA-12 (PPO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC WA-12 (PPO) covers ground and air ambulance services with a $290 copay and no coinsurance, though prior authorization is required. Routine transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
AARP Medicare Advantage from UHC WA-12 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a copay ranging from $0 to $50 with 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-12 (PPO) provides primary care, telehealth, and opioid treatment services with no copay and no coinsurance, while specialist visits require a $0 to $60 copay and no coinsurance. Other covered benefits, including mental health, podiatry, and physical, occupational, and speech therapies, feature no coinsurance and copays ranging from $0 to $55, though chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by AARP Medicare Advantage from UHC WA-12 (PPO) with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and EKGs. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
AARP Medicare Advantage from UHC WA-12 (PPO) partially covers hearing services, which include one annual routine hearing exam with no copay or coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids are covered with a copay of $199 to $1,249 and no coinsurance for up to two devices per year, but inner ear, outer ear, and over the ear types are not covered. OTC hearing aids are covered with a copay of $199 to $829 and no coinsurance for up to two devices per year.
Vision Services See details
Vision services are partially covered by AARP Medicare Advantage from UHC WA-12 (PPO) with no deductibles and no coinsurance. Routine eye exams have no copay (one per year), and eyewear features a $300 combined limit every two years with no copay for contacts and frames and a $0 to $153 copay for lenses; however, other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services under AARP Medicare Advantage from UHC WA-12 (PPO) are partially covered, featuring no copay and no coinsurance for preventive care such as cleanings, exams, and x-rays, and no copay with a 20% coinsurance for Medicare-covered dental. However, restorative services, endodontics, periodontics, prosthodontics, oral surgery, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by AARP Medicare Advantage from UHC WA-12 (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, insulin, and other drugs carry no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage from UHC WA-12 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
AARP Medicare Advantage from UHC WA-12 (PPO) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the AARP Medicare Advantage from UHC WA-12 (PPO) plan, featuring no copay for lab services and diagnostic radiology, alongside no coinsurance for diagnostic services. Members will pay a $45 copay for diagnostic procedures, a $30 copay for outpatient X-rays, and a 20% coinsurance for therapeutic radiology, with prior authorization required for these services.
Home Health Services See details
Home Health Services are covered under the AARP Medicare Advantage from UHC WA-12 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
AARP Medicare Advantage from UHC WA-12 (PPO) provides coverage for Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC WA-12 (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 to 20 and a $218 daily copay for days 21 to 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
AARP Medicare Advantage from UHC WA-12 (PPO) partially covers other services, which includes a chronic illness meal benefit with no copay and no coinsurance, though prior authorization is required. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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