AARP Medicare Advantage from UHC FG-0002 (PPO)

Inpatient Hospital See details

Inpatient hospital services, including acute and psychiatric care, are covered. For acute care, you will pay a $450 copay for days 1-4, and no copay for days 5-90, with no coinsurance; additional days (91-999) have no copay. For psychiatric care, you will pay a $450 copay for days 1-3, and no copay for days 4-90, with no coinsurance.

Outpatient Services See details

Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $450, and for observation services with a $450 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a copay between $0 and $15 for individual sessions, and a $15 copay for group sessions.

Partial Hospitalization See details

Partial Hospitalization is covered under the AARP Medicare Advantage from UHC FG-0002 (PPO) plan, but requires prior authorization. The copay for this benefit is $55.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered, including both ground and air ambulance services with a $290 copay, but there is no coinsurance. Transportation services to a health-related location are not covered.

Emergency Services See details

Emergency Services under the AARP Medicare Advantage from UHC FG-0002 (PPO) plan includes a $125 copay for emergency services, no coinsurance, and the copay is waived if admitted to the hospital within 24 hours. Urgently Needed Services have a copay between $0 and $55 and no coinsurance, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.

Primary Care See details

The AARP Medicare Advantage from UHC FG-0002 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a copay between $0 and $35, and physician specialist services with a copay between $0 and $45. The plan also covers mental health specialty services with a copay between $0 and $15 for individual sessions and a $15 copay for group sessions, podiatry services with a $35 copay, other health care professional services with a copay between $0 and $45, psychiatric services with a copay between $0 and $15 for individual sessions and a $15 copay for group sessions, physical therapy and speech-language pathology services with a copay between $0 and $35, additional telehealth benefits with no copay, and opioid treatment program services with no copay. Routine chiropractic care is not covered.

Preventive Services See details

Preventive services, including annual physical exams, are covered. Annual physical exams have no copay, and the plan also covers additional preventive services, kidney disease education, and other preventive services with no copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit.

Hearing Services See details

Hearing exams are covered with no copay. Prescription hearing aids are covered, with a copay between $199 and $1249, depending on the type of hearing aid. OTC hearing aids are covered with a copay between $99 and $829. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.

Vision Services See details

Vision Services include coverage for eye exams and eyewear. Eye exams have no copay, and routine eye exams are limited to one per year. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $200 every two years, and contact lenses have no copay. Eyeglasses (lenses and frames) and upgrades are not covered.

Dental Services See details

Dental services are covered by AARP Medicare Advantage from UHC FG-0002 (PPO). Medicare dental services have a 20% coinsurance, while oral exams, dental X-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0% and 20%. Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered under the AARP Medicare Advantage from UHC FG-0002 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is between 20% and 20%.

Medical Equipment See details

Medical Equipment is covered under the AARP Medicare Advantage from UHC FG-0002 (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered.

Prosthetic Devices have a 20% coinsurance with no copay, and Medical Supplies have a 20% coinsurance with no copay.

Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered by AARP Medicare Advantage from UHC FG-0002 (PPO). Diagnostic Procedures/Tests have a $50 copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $240, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $25 copay.

Home Health Services See details

Home Health Services are covered by AARP Medicare Advantage from UHC FG-0002 (PPO) with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are covered, but all sub-services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the AARP Medicare Advantage from UHC FG-0002 (PPO) plan, with a prior authorization requirement. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered 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.