AARP Medicare Advantage Essentials from UHC SC-3 (PPO)

Inpatient Hospital See details

Inpatient Hospital benefits, including acute and psychiatric care, are covered under this plan. For days 1-5 of inpatient hospital stays, there is a $330 copay, and for days 6-90, there is no copay, while additional days for Inpatient Hospital-Acute have no copay.

Outpatient Services See details

Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $330, observation services have a $330 copay, and ambulatory surgical center services have no copay.

Outpatient substance abuse services, including individual and group sessions, are covered, with individual sessions having a copay between $0 and $25 and group sessions having a $15 copay. Outpatient blood services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered by the AARP Medicare Advantage Essentials from UHC SC-3 (PPO) plan, but requires prior authorization. The copay for this benefit is $55.

Ambulance and Transportation Services See details

The AARP Medicare Advantage Essentials from UHC SC-3 (PPO) plan covers ambulance services with a $275 copay for both ground and air ambulance services, but transportation services to any health-related location are not covered. There is no coinsurance for ambulance services.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the AARP Medicare Advantage Essentials from UHC SC-3 (PPO) plan. For Emergency Services, there is a $125 copay, and no coinsurance. For Urgently Needed Services, the copay is between $0 and $55, and there is no coinsurance. Worldwide Emergency, Urgent Coverage, and Emergency Transportation have no copay and no coinsurance.

Primary Care See details

The AARP Medicare Advantage Essentials from UHC SC-3 (PPO) plan offers primary care services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a copay between $0 and $30. Physician specialist services have a copay between $0 and $40, while mental health and psychiatric services have varying copays depending on the service. Podiatry services have a $40 copay, other health care professional services have a copay between $0 and $40, physical therapy and speech-language pathology services have a copay between $0 and $30, and additional telehealth benefits have no copay. Opioid treatment program services have no copay.

Preventive Services See details

Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered, with the copay information available in the details section. Fitness benefits and remote access technologies have no copay. This plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.

Hearing Services See details

Hearing exams are covered with no copay. Prescription hearing aids are covered with a copay between $199 and $1249, while OTC hearing aids have a copay between $99 and $829. Fitting/evaluation for hearing aids, and prescription hearing aids for inner ear, outer ear, and over the ear are not covered.

Vision Services See details

The AARP Medicare Advantage Essentials from UHC SC-3 (PPO) plan covers vision services, including routine eye exams and eyewear. Routine eye exams have no copay, and you are limited to one exam per year. Eyewear has a combined maximum benefit of $200 every two years and includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay. Eyeglass frames are limited to one frame every two years. However, eyeglasses (lenses and frames) and upgrades are not covered.

Dental Services See details

Dental Services are covered, with a 20% coinsurance for Medicare Dental Services, while Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services have no copay. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered by AARP Medicare Advantage Essentials from UHC SC-3 (PPO). Medicare Part B Insulin Drugs have a $35 copay, and a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered by the AARP Medicare Advantage Essentials from UHC SC-3 (PPO) plan, but prior authorization is required. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, with a minimum copay of $25 for Diagnostic Procedures/Tests and a $0 copay for Lab Services. Diagnostic Radiological Services have a maximum copay of $155, Therapeutic Radiological Services have a copay of $80, and Outpatient X-Ray Services have a copay of $15.

Home Health Services See details

Home Health Services are covered by the AARP Medicare Advantage Essentials from UHC SC-3 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization is required for this benefit.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.

Other Services See details

Other Services includes a meal benefit with no copay, but acupuncture, over-the-counter items, 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.