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AARP Medicare Advantage from UHC SC-0004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC SC-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 SC-0004 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC SC-0004 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in South 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 SC-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 SC-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 SC-0004 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.00. 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 SC-0004 (PPO) plan features an annual drug deductible of $440. For Tier 1 preferred generic drugs, you will pay no copay for 1-month or 3-month supplies at standard pharmacies and through mail order. Tier 2 generic drugs have a $10 copay for a 1-month supply at standard pharmacies, but you can get a 3-month supply with no copay when using preferred mail order. Tier 3 preferred brand drugs require a 15% coinsurance for both 1-month and 3-month supplies across standard pharmacies and mail order options. Higher-tier medications carry coinsurance rates of 37% for Tier 4 non-preferred drugs and 28% for Tier 5 specialty drugs. These straightforward cost-sharing details help you estimate your out-of-pocket prescription costs under this PPO plan.
Additional Benefits
The AARP Medicare Advantage from UHC SC-0004 (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. Specialist visits feature a copay ranging from no copay to $50, while inpatient hospital stays require a $395 daily copay for the first five days and no copay for days six through 90. Outpatient hospital services range from no copay to a $395 copay, and emergency room visits carry a $130 copay with no coinsurance. For supplemental care, members enjoy routine eye exams, preventive dental care, and annual hearing exams with no copay, though comprehensive dental services are not covered. Prescription hearing aids require copays between $199 and $1,249, while covered eyewear is subject to a $300 limit every two years with no deductible. Other essential services, including durable medical equipment and dialysis, are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
AARP Medicare Advantage from UHC SC-0004 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $395 daily copay for days 1 to 5 and no copay for days 6 to 90. While unlimited additional acute days are covered with no copay, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC SC-0004 (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $395 copay and ambulatory surgical center services with no copay. Outpatient blood services feature no copay or coinsurance, while outpatient substance abuse services have a copay ranging from $0 to $25 with no coinsurance.
Partial Hospitalization See details
AARP Medicare Advantage from UHC SC-0004 (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC SC-0004 (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the AARP Medicare Advantage from UHC SC-0004 (PPO) are covered with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require 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
AARP Medicare Advantage from UHC SC-0004 (PPO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits range from a $0 to $50 copay with no coinsurance. Physical, occupational, and speech therapies require a $30 copay with no coinsurance, and while chiropractic services are technically covered, routine and other chiropractic services are not covered.
Preventive Services See details
AARP Medicare Advantage from UHC SC-0004 (PPO) provides preventive services with no copay and no coinsurance, including annual physicals, kidney education, and fitness benefits. This benefit is partially covered as it excludes health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, remote technologies, safety devices, and counseling.
Hearing Services See details
AARP Medicare Advantage from UHC SC-0004 (PPO) provides partially covered hearing services, including one annual routine hearing exam with no copay and no coinsurance, though fitting and evaluation exams are not covered. Up to two prescription hearing aids per year are partially covered with a $199 to $1,249 copay and no coinsurance, excluding inner ear, outer ear, and over-the-ear models. Additionally, up to two over-the-counter (OTC) hearing aids are covered annually with a $199 to $829 copay and no coinsurance.
Vision Services See details
AARP Medicare Advantage from UHC SC-0004 (PPO) provides partially covered vision services with no deductible, featuring no copay and no coinsurance for one routine eye exam per year, eyeglass frames, or contact lenses. Covered eyewear is subject to a combined $300 limit every two years, with eyeglass lenses carrying a copay of $0 to $153 and no coinsurance, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage from UHC SC-0004 (PPO) partially covers dental services, offering Medicare-covered dental with no copay and a 20% coinsurance, plus preventive care like exams and cleanings with no copay and no coinsurance. However, comprehensive dental services such as restorative treatments, endodontics, periodontics, prosthodontics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by AARP Medicare Advantage from UHC SC-0004 (PPO) with no copay, though prior authorization is required. Under this benefit, covered Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by AARP Medicare Advantage from UHC SC-0004 (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by AARP Medicare Advantage from UHC SC-0004 (PPO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are offered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC SC-0004 (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and diagnostic radiological services feature no copay, while diagnostic tests require a $40 copay, outpatient X-rays require a $30 copay, and therapeutic radiological services carry a minimum $50 copay.
Home Health Services See details
The AARP Medicare Advantage from UHC SC-0004 (PPO) plan covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by AARP Medicare Advantage from UHC SC-0004 (PPO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for peripheral artery disease rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC SC-0004 (PPO) covers skilled nursing facility services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day hospital stay prior to admission is not required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
AARP Medicare Advantage from UHC SC-0004 (PPO) partially covers other services, providing a chronic illness meal benefit with no copay and no coinsurance, though prior authorization is required. Acupuncture, over-the-counter (OTC) items, and other supplemental services are not covered under this plan.
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