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AARP Medicare Advantage from UHC VA-0004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC VA-0004 (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 VA-0004 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC VA-0004 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Virginia. 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 VA-0004 (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 VA-0004 (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 VA-0004 (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 $440.00 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 VA-0004 PPO plan features an annual drug deductible of $440. Tier 1 preferred generic drugs have no copay for one-month and three-month supplies at standard pharmacies, and no copay for three-month mail-order supplies. Tier 2 generic drugs require an $8 copay for a one-month standard pharmacy supply, but you can receive a three-month supply with no copay when using preferred mail order. For brand name and specialty medications, your costs are based on coinsurance. Tier 3 preferred brand drugs carry a 16% coinsurance for both standard retail and mail-order options. Tier 4 non-preferred drugs require a 41% coinsurance, while Tier 5 specialty drugs have a 28% coinsurance for a one-month supply across standard pharmacies and mail order.
Additional Benefits
The AARP Medicare Advantage from UHC VA-0004 (PPO) plan offers comprehensive coverage for core medical services, featuring no copay and no coinsurance for primary care visits and routine preventive services. Specialist visits are highly affordable with copays ranging from no copay to $45, while inpatient hospital stays require a $395 daily copay for the first five days and no copay for subsequent days. Emergency care is covered with a $130 copay, which is waived upon admission, and worldwide emergency services require no copay. For ancillary care, members receive diagnostic and preventive dental services, annual routine hearing exams, and routine eye exams with no copay. The plan also provides up to $3,000 in dental coverage with 20% to 50% coinsurance for advanced procedures, alongside a $250 eyewear allowance every two years. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by AARP Medicare Advantage from UHC VA-0004 (PPO) with no coinsurance, requiring a $395 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by AARP Medicare Advantage from UHC VA-0004 (PPO) with no coinsurance, featuring copays ranging from $0 to $395 for outpatient hospital and observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions have no coinsurance and copays ranging from $0 to $25.
Partial Hospitalization See details
Partial hospitalization services are covered by the AARP Medicare Advantage from UHC VA-0004 (PPO) plan with a $55 copayment and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC VA-0004 (PPO) partially covers ambulance and transportation services, featuring a $275 copay and no coinsurance for both ground and air ambulance trips. 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 VA-0004 (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 feature no copay to a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Primary care benefits under the AARP Medicare Advantage from UHC VA-0004 (PPO) are covered with no copay and no coinsurance, while specialist visits feature a $0 to $45 copay and no coinsurance. Physical, occupational, and speech therapies require a $30 copay with no coinsurance, though chiropractic services are not covered in practice.
Preventive Services See details
Preventive Services are partially covered by the AARP Medicare Advantage from UHC VA-0004 (PPO) plan with no copay and no coinsurance for covered options like annual physical exams, fitness benefits, and kidney disease education. However, several supplemental services are not covered, including health education, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services under the AARP Medicare Advantage from UHC VA-0004 (PPO) plan are partially covered, offering one annual routine hearing exam with no copay, no coinsurance, and no deductible, though fitting and evaluation exams are not covered. Prescription and OTC hearing aids are covered up to two per year with no coinsurance, featuring copays ranging from $199.00 to $1,249.00 for prescription aids and $199.00 to $829.00 for OTC aids, but inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by AARP Medicare Advantage from UHC VA-0004 (PPO) with no deductible and no coinsurance, though upgrades, other eye exams, and combined eyeglasses (lenses and frames) are not covered. Routine eye exams are covered with no copay (one per year), and eyewear is covered up to a $250 combined limit every two years with no copay for contacts and frames, and a $0 to $153 copay for lenses.
Dental Services See details
Dental services under the AARP Medicare Advantage from UHC VA-0004 (PPO) plan are partially covered up to a $3,000 annual limit, though implant services and orthodontics are not covered. Diagnostic and preventive services feature no copay and no coinsurance, while Medicare-covered services require no copay and a 20% coinsurance, and covered comprehensive services require no copay and a 50% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by AARP Medicare Advantage from UHC VA-0004 (PPO) with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance. Part B insulin is also covered under this benefit with a $35 copay and no coinsurance to 20% coinsurance, with prior authorization required for services.
Dialysis Services See details
AARP Medicare Advantage from UHC VA-0004 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to access these covered services.
Medical Equipment See details
AARP Medicare Advantage from UHC VA-0004 (PPO) covers durable medical equipment, prosthetics, and diabetic therapeutic shoes with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services under the AARP Medicare Advantage from UHC VA-0004 (PPO) plan are covered with no coinsurance, though prior authorization is required. Members pay no copay for lab services, a $15 copay for diagnostic tests, a $25 copay for outpatient X-rays, and copays starting at $0 for diagnostic radiology and $50 for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by AARP Medicare Advantage from UHC VA-0004 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by AARP Medicare Advantage from UHC VA-0004 (PPO) with no coinsurance, though in practice only some services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AARP Medicare Advantage from UHC VA-0004 (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services are partially covered by AARP Medicare Advantage from UHC VA-0004 (PPO), offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required for the meal benefit.
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