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AARP Medicare Advantage from UHC NC-0003 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NC-0003 (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 NC-0003 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage from UHC NC-0003 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in North Carolina. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that AARP Medicare Advantage from UHC NC-0003 (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 NC-0003 (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 NC-0003 (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 $420.00 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 AARP Medicare Advantage from UHC NC-0003 (PPO) plan has a $420 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, standard generic drugs have a $5 copay, while preferred brand drugs have a $100 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. However, if you qualify for the low-income subsidy, you will pay no copay for your Part D drugs.
Additional Benefits
The AARP Medicare Advantage from UHC NC-0003 (PPO) plan offers a range of benefits with varying cost-sharing. This plan includes coverage for inpatient hospital stays with a copay, outpatient services, and emergency services with copays, and offers no copay for many services, including primary care, preventive services, and home health services. The plan also covers hearing and vision services with no copay, and dental services with a 20% coinsurance. Additional benefits include coverage for ambulance services, with a copay, and partial hospitalization with a $55 copay. The plan also provides coverage for home infusion services, dialysis services, medical equipment, and diagnostic and radiological services with varying copays and coinsurance. The plan also covers Skilled Nursing Facility (SNF) services with a copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $445 per admission for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric has a copay of $445 for days 1-4, and no copay for days 5-90; additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $445, Observation Services with a $445 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by AARP Medicare Advantage from UHC NC-0003 (PPO), with a $145 copay for both ground and air ambulance services, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the AARP Medicare Advantage from UHC NC-0003 (PPO) plan. Emergency Services have a $110 copay and no coinsurance, Urgently Needed Services have a copay between $0 and $45 with no coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay and no coinsurance.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, and Additional Telehealth Benefits have no copay. Chiropractic Services have a $15 copay, while Physician Specialist Services have a copay between $0 and $40. Mental Health Specialty Services and Psychiatric Services have a copay between $0 and $25 for individual sessions and a $15 copay for group sessions. Podiatry Services and Opioid Treatment Program Services have a $35 copay. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $35.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additional preventive services are covered, including Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Some services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services.
Hearing Services See details
Hearing exams are covered with no copay, while routine hearing exams are limited to one per year with no copay. Prescription hearing aids are partially covered, with a copay between $199 and $1249 for all types, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids have a copay between $99 and $829.
Vision Services See details
Vision Services includes routine eye exams with no copay, and eyewear benefits. Eyewear benefits include contact lenses, eyeglass lenses, and eyeglass frames, all with no copay, and a combined maximum benefit of $300 every two years. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams, dental x-rays, cleaning, fluoride treatment, and other preventive services, with no copay; however, there is a 20% coinsurance for Medicare dental services. Orthodontic, restorative, and other dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by AARP Medicare Advantage from UHC NC-0003 (PPO). Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%; Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage from UHC NC-0003 (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and no copay, though DME for use outside the home is not covered. Prosthetic Devices and Medical Supplies are covered with 20% coinsurance and no copay. Diabetic Equipment, including Diabetic Supplies with no copay, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance, are covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $25 copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $205, Therapeutic Radiological Services with a copay of $80, and Outpatient X-Ray Services with a $15 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage from UHC NC-0003 (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 specific services listed, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the AARP Medicare Advantage from UHC NC-0003 (PPO) plan with prior authorization required. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The AARP Medicare Advantage from UHC NC-0003 (PPO) plan covers Over-the-Counter (OTC) Items and Meal Benefits. Over-the-Counter (OTC) Items have no copay, and Meal Benefits also have 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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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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