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AARP Medicare Advantage from UHC NC-0004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NC-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 NC-0004 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC NC-0004 (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 4.5 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage from UHC NC-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 NC-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 NC-0004 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 NC-0004 (PPO) plan features an annual prescription drug deductible of $440. For Tier 1 preferred generic drugs, members pay no copay for standard pharmacy fills or three-month mail orders. Tier 2 generic drugs cost an $8 copay for a one-month standard pharmacy supply, though a three-month preferred mail order is available with no copay. Tier 3 preferred brand drugs require an 18% coinsurance for standard pharmacy and mail order options. For higher-tier medications, Tier 4 non-preferred drugs carry a 39% coinsurance for a one-month supply. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply across standard pharmacies and mail order options.
Additional Benefits
The AARP Medicare Advantage from UHC NC-0004 (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, telehealth, and annual physicals, while specialist visits require a low copay of up to $40. For inpatient hospital stays, there is no coinsurance and a $425 daily copay for the first five days, followed by no copay for days six through ninety. Outpatient services, emergency care, and diagnostic lab tests are also highly accessible, featuring no coinsurance and copays ranging from no copay to $425 depending on the specific service. This plan also includes valuable supplemental benefits, such as dental coverage with a $2,000 annual maximum that features no copay for diagnostic and preventive services. Vision and hearing benefits offer routine annual exams with no copay, along with coverage for prescription eyewear and hearing aids at varying copay levels. Additionally, home health care and cardiac rehabilitation services are covered with no copay and no coinsurance, while durable medical equipment requires no copay and a 20% coinsurance.
Inpatient Hospital See details
AARP Medicare Advantage from UHC NC-0004 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $425 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by AARP Medicare Advantage from UHC NC-0004 (PPO) require prior authorization and feature no coinsurance. Copays range from $0 to $425 for outpatient hospital and observation services, while ambulatory surgical center and blood services have no copay, and outpatient substance abuse sessions require a $0 to $25 copay.
Partial Hospitalization See details
AARP Medicare Advantage from UHC NC-0004 (PPO) covers partial hospitalization with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC NC-0004 (PPO) covers ground and air ambulance services with a $290 copay and no coinsurance, though prior authorization is required. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
AARP Medicare Advantage from UHC NC-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 a copay of $0 to $50 and 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 NC-0004 (PPO) offers primary care provider visits, telehealth, and opioid treatment with no copay and no coinsurance, while specialist and other professional visits range from a $0 to $40 copay with no coinsurance. Physical, occupational, speech, mental health, and podiatry services range from a $0 to $40 copay with no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by the AARP Medicare Advantage from UHC NC-0004 (PPO) plan, offering covered services like annual physicals, kidney disease education, and glaucoma screenings with no copay and no coinsurance. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, and nutritional or weight management programs.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC NC-0004 (PPO), which features one routine hearing exam per year with no copay and no coinsurance, while fitting and evaluation exams are not covered. Up to two prescription hearing aids (copays of $199 to $1,249) and two OTC hearing aids (copays of $199 to $829) are covered annually with no coinsurance, though 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 NC-0004 (PPO) with no deductible and no coinsurance, featuring no copay for annual routine eye exams, contact lenses, and eyeglass frames, while eyeglass lenses require a copay of $0 to $153 up to a combined $300 limit every two years. Other eye exam services, upgrades, and bundled eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered under the AARP Medicare Advantage from UHC NC-0004 (PPO) plan, which features a $2,000 annual maximum benefit for both in-network and out-of-network care. Diagnostic and preventive services are offered with no copay and no coinsurance, Medicare-covered services require no copay and 20% coinsurance, and comprehensive services require no copay and 50% coinsurance, though implant services and orthodontics are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC NC-0004 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs under this benefit have no copay and require no coinsurance to 20% coinsurance, while covered Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
AARP Medicare Advantage from UHC NC-0004 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
AARP Medicare Advantage from UHC NC-0004 (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC NC-0004 (PPO) covers diagnostic and radiological services with prior authorization required, offering lab services and diagnostic radiological services with no copay and no coinsurance. Outpatient diagnostic procedures and tests require a $50 copay with no coinsurance, outpatient X-rays require a $25 copay, and therapeutic radiological services incur a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the AARP Medicare Advantage from UHC NC-0004 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no copay and no coinsurance under AARP Medicare Advantage from UHC NC-0004 (PPO), though prior authorization is required. Only some services are covered, as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC NC-0004 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not needed for admission, additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Other Services are partially covered by the AARP Medicare Advantage from UHC NC-0004 (PPO) plan, which includes a meal benefit for chronic illnesses with no copay, no coinsurance, and prior authorization required. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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