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AARP Medicare Advantage from UHC WA-16 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC WA-16 (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 WA-16 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage from UHC WA-16 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Washington. 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 WA-16 (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 WA-16 (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 WA-16 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. 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 $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 WA-16 (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $420. Once you meet your deductible, you will pay the following costs for your prescriptions. For drugs in the initial coverage phase, you will pay a $12 copay for preferred generic drugs at a standard pharmacy, and $47 for standard generic drugs at a standard pharmacy. Preferred brand drugs have a $100 copay, no matter the pharmacy. Non-preferred drugs have a 28% coinsurance. After your total yearly drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The AARP Medicare Advantage from UHC WA-16 (PPO) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a $375 copay for the first four days, with no copay for the remainder of the stay. Outpatient services have a mix of copays, while emergency services have a $125 copay. Preventive services, including an annual physical exam, have no copay, and hearing exams are also covered with no copay. Vision services include eye exams with no copay. The plan also covers dental services with no copay for many services, and ambulance services have a $290 copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-4 of an inpatient hospital stay, the copay is $375, and for days 5-90, there is no copay; additional days have no copay.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay of $0-$375, observation services have a $375 copay, ambulatory surgical center services have no copay, individual outpatient substance abuse sessions have a $0-$25 copay, group outpatient substance abuse sessions have a $15 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the AARP Medicare Advantage from UHC WA-16 (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 by AARP Medicare Advantage from UHC WA-16 (PPO), with no coinsurance. Ground and Air Ambulance Services have a copay of $290.00, while 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 WA-16 (PPO) plan. Emergency Services has a $125 copay, and Urgently Needed Services have a copay between $0 and $55; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services and a $10 copay for Chiropractic Services, including routine care, with a limit of 12 visits per year. Occupational Therapy Services have a copay between $0 and $30, and Physician Specialist Services have a copay between $0 and $35. Mental Health and Psychiatric Services, including individual and group sessions, also have copays. Podiatry services have a $35 copay for Medicare-covered services and routine foot care, with a limit of 6 visits per year. Other Health Care Professional services have a copay between $0 and $35. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $30. Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services. Additional preventive services include Fitness Benefit, and Home and Bathroom Safety Devices and Modifications with no copay, and Alternative Therapies with a $10 copay. 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, 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, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, routine hearing exams limited to one per year with no copay, and OTC hearing aids with a copay between $99 and $829. Prescription hearing aids are partially covered, with copays between $199 and $1249 for all types, but inner ear, outer ear, and over the ear hearing aids are not covered, and fitting/evaluation for hearing aids is not covered.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams and eyewear have no copay, and contact lenses, eyeglass lenses, and eyeglass frames also have no copay; however, eyeglass lenses may have a copay from $0 to $153. Eyeglass frames are limited to one pair every two years, and eyeglass lenses are limited to one pair every two years. Eyeglass frames and upgrades are not covered.
Dental Services See details
The AARP Medicare Advantage from UHC WA-16 (PPO) plan covers dental services, including oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatment, and other preventive services with no copay. Medicare dental services have a 20% coinsurance. Restorative services, endodontics, periodontics, maxillofacial prosthetics, and oral surgery are covered with no copay. Prosthodontics (removable and fixed) have a 0-50% coinsurance. However, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage from UHC WA-16 (PPO) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance, while Diabetic Equipment has varying cost sharing depending on the specific supply or service. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a $50 copay, lab services with no copay, and outpatient X-ray services with a $25 copay. Diagnostic radiological services have a maximum copay of $160, and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the AARP Medicare Advantage from UHC WA-16 (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 AARP Medicare Advantage from UHC WA-16 (PPO), but none of the listed sub-services are covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will have 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 stays for SNF are not covered.
Other Services See details
The AARP Medicare Advantage from UHC WA-16 (PPO) plan covers acupuncture with a $10 copay for 12 treatments per year, over-the-counter (OTC) items with no copay, and a meal benefit with no copay, though the meal benefit requires prior authorization. Several additional services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and Case Management (Long Term Care).
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