AARP Medicare Advantage from UHC WA-12 (PPO)

Inpatient Hospital See details

Inpatient hospital services are covered, with a copay of $390 for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital-acute have no copay. Non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are also not covered.

Outpatient Services See details

Outpatient Services are covered by the AARP Medicare Advantage from UHC WA-12 (PPO) plan. Outpatient Hospital Services have a copay between $0 and $390, Observation Services have a $390 copay, and Ambulatory Surgical Center (ASC) Services have no copay.

Individual sessions for Outpatient Substance Abuse have a copay between $0 and $25, while Group Sessions have a $15 copay; Outpatient Blood Services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered with a $55 copay, and prior authorization is required.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the AARP Medicare Advantage from UHC WA-12 (PPO) plan. Ground and air ambulance services have a copay of $290, and there is no coinsurance; however, transportation services to any health-related location are not covered.

Emergency Services See details

Emergency Services, including Urgent and Worldwide Emergency Services, are covered. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0-$45. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.

Primary Care See details

Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with a $20 copay. Occupational Therapy Services are covered with a copay between $0 and $45, and Physician Specialist Services are covered with a copay between $0 and $45. Mental Health Specialty Services and Psychiatric Services individual sessions have a copay between $0 and $25, and group sessions have a $15 copay. Podiatry Services and Other Health Care Professional services have a copay of $40. Physical Therapy and Speech-Language Pathology Services are covered with a copay between $0 and $50, and Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have no copay.

Preventive Services See details

Preventive Services include coverage for Medicare-covered services with no copay, as well as an annual physical exam with no copay. Other services like health education, in-home safety assessments, and more are not covered.

Hearing Services See details

Hearing exams are covered with no copay. Prescription hearing aids are covered with a copay between $199 and $1249, depending on the specific aid, while OTC hearing aids are covered with a copay between $99 and $829. Fitting/Evaluation for Hearing Aids, 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 include eye exams and eyewear. Eye exams have no copay. Eyewear has a combined maximum plan benefit of $300 every two years, and contact lenses, eyeglass lenses, and eyeglass frames have no copay; however, eyeglasses (lenses and frames) and upgrades are not covered.

Dental Services See details

Dental Services are covered, including Medicare Dental Services with 20% coinsurance and Other Dental Services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery have no copay, but Prosthodontics and fixed have a coinsurance of 0% - 50%. Orthodontic and Implant Services are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered under the AARP Medicare Advantage from UHC WA-12 (PPO) plan. You will pay 20% coinsurance. Prior authorization is required.

Medical Equipment See details

Medical equipment is covered, but durable medical equipment for use outside the home is not covered. For durable medical equipment, you will pay 20% coinsurance and there is no copay. Prosthetic devices and medical supplies are covered, with a 20% coinsurance, and diabetic equipment is covered with both coinsurance and copay, but more information is needed.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services include coverage for all diagnostic services with a $40 copay, lab services with no copay, and diagnostic radiological services with a copay up to $170. Therapeutic Radiological Services have a coinsurance of at least 20%, and outpatient X-ray services have a $25 copay.

Home Health Services See details

Home Health Services are covered by the AARP Medicare Advantage from UHC WA-12 (PPO) plan with no copay and no coinsurance. 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 under the AARP Medicare Advantage from UHC WA-12 (PPO) plan, with a $0 copay for days 1-20 and a $203 copay for days 21-100; however, additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.

Other Services See details

Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits, with OTC items having no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.