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UHC Medicare Advantage TC-0001 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Medicare Advantage TC-0001 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Medicare Advantage TC-0001 (PPO) in 2025, please refer to our full plan details page.
UHC Medicare Advantage TC-0001 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Tennessee & Virginia. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Medicare Advantage TC-0001 (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 UHC Medicare Advantage TC-0001 (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 UHC Medicare Advantage TC-0001 (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. Additionally, this plan comes with a Part B Premium reduction of $11.00. You must continue to pay paying your reduced 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 $255.00 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 UHC Medicare Advantage TC-0001 (PPO) plan has a $255.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, $47.00 for standard generic drugs, and $100.00 for preferred brand drugs. Non-preferred drugs have a 30% coinsurance. After your total drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The UHC Medicare Advantage TC-0001 (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, and outpatient services with copays that vary by service. It also includes coverage for emergency services, primary care with no copay, and preventive services. The plan also covers hearing and vision services, dental services, and home health services. Additional benefits include ambulance services, partial hospitalization, and home infusion. The plan also offers coverage for diagnostic and radiological services, cardiac rehabilitation services, and skilled nursing facility stays. However, some services like certain dental, vision, and home health services, as well as additional services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered with a $295 copay for days 1-5 and no copay for days 6-90, with additional days for acute inpatient hospital covered with no copay. Non-Medicare-covered stays and upgrades for inpatient hospital are not covered, and additional days for inpatient psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $295, observation services with a $295 copay, and ambulatory surgical center services with no copay. Additionally, outpatient substance abuse services have copays ranging from $0 to $25 for individual sessions, and $15 for group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the UHC Medicare Advantage TC-0001 (PPO) plan. Ground and Air Ambulance Services have a copay of $290, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by UHC Medicare Advantage TC-0001 (PPO) with a $125 copay and no coinsurance. Urgently Needed Services have a copay between $0 and $55, with no coinsurance. Worldwide Emergency Services are covered, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, all with no copay and no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay, but Routine Chiropractic Care is not covered. Occupational Therapy Services are covered with a copay between $0 and $35. Physician Specialist Services have a copay between $0 and $35. Mental Health Specialty Services have a copay, with Individual Sessions for Mental Health Specialty Services having a copay between $0 and $25 and Group Sessions for Mental Health Specialty Services having a $15 copay. Podiatry Services have a $25 copay for Medicare-covered Podiatry Services and Routine Foot Care. Other Health Care Professional services have a copay between $0 and $35. Psychiatric Services have a copay, with Individual Sessions for Psychiatric Services having a copay between $0 and $25 and Group Sessions for Psychiatric Services having a $15 copay. Physical Therapy and Speech-Language Pathology Services are covered with a copay between $0 and $40. Additional Telehealth Benefits are covered with no copay. Opioid Treatment Program Services are covered with no copay.
Preventive Services See details
Preventive services include Medicare-covered services and an annual physical exam with no copay, as well as additional services like fitness benefits with no copay. Health education, in-home safety assessment, personal emergency response system, 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, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following the Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with no copay, while routine hearing exams are limited to 1 per year. Prescription hearing aids are covered with a copay between $199 and $1249 for all types, with a limit of 2 per year, while OTC hearing aids have a copay between $99 and $829.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and include routine eye exams. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay. 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. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the UHC Medicare Advantage TC-0001 (PPO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Medicare Advantage TC-0001 (PPO) plan, with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME and Prosthetic Devices have a 20% coinsurance, while Medical Supplies also have a 20% coinsurance; Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 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, including Diagnostic Procedures/Tests with a $25 copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $150, Therapeutic Radiological Services with a copay of $60, and Outpatient X-Ray Services with a $10 copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the UHC Medicare Advantage TC-0001 (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 by UHC Medicare Advantage TC-0001 (PPO), 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 for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Medicare Advantage TC-0001 (PPO) plan 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 for SNF and non-Medicare-covered stays for SNF 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.
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