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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 2026, 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 4.5 out of 5 stars in 2026.
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 $56.00. 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 $600.00 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 features an annual drug deductible of $600. Under this plan, Tier 1 preferred generic drugs have no copay for 1-month or 3-month supplies at standard pharmacies and through mail order. Tier 2 generic drugs require a $12 copay for a 1-month supply at standard pharmacies, but they feature no copay when ordering a 3-month supply through preferred mail order. For Tier 3 preferred brand drugs, you will pay a 15% coinsurance for both 1-month and 3-month supplies. Tier 4 non-preferred drugs and Tier 5 specialty drugs require a coinsurance of 40% and 26% respectively for a 1-month supply. These coinsurance rates apply whether you fill your prescriptions at a standard pharmacy or through mail order services.
Additional Benefits
The AARP Medicare Advantage from UHC WA-16 (PPO) plan offers robust coverage for everyday medical needs, including primary care visits, annual physicals, and home health services with no copay and no coinsurance. For inpatient hospital stays, members pay a $425 daily copay for the first five days and no copay for days six through 90. Emergency room visits carry a $130 copay, which is waived if admitted, while worldwide emergency services are available with no copay. Specialist visits and physical therapy require low copays ranging from $0 to $50, while dental care features a $1,000 annual benefit limit with no copay for diagnostic and preventive services. Vision benefits include a routine annual exam with no copay and a $300 eyewear allowance every two years. Additionally, routine hearing exams have no copay, and prescription hearing aids are covered with copays ranging from $199 to $1,249.
Inpatient Hospital See details
AARP Medicare Advantage from UHC WA-16 (PPO) covers inpatient hospital services with no coinsurance, featuring a $425 daily copay for days 1 through 5 and no copay for days 6 through 90 for both acute and psychiatric stays. Unlimited additional acute days are covered at no copay, though psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC WA-16 (PPO) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital and observation services require copays ranging from $0 to $425, while outpatient substance abuse services have copays of $0 to $25, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered under the AARP Medicare Advantage from UHC WA-16 (PPO) plan with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services through the AARP Medicare Advantage from UHC WA-16 (PPO) plan cover ground and air ambulance services with a $290 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
AARP Medicare Advantage from UHC WA-16 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a copay ranging from $0 to $50 and no coinsurance, while worldwide emergency, urgent, and transportation services are fully covered with no copay and no coinsurance.
Primary Care See details
AARP Medicare Advantage from UHC WA-16 (PPO) covers primary care physician visits and telehealth services with no copay and no coinsurance. Other services, including specialist visits, physical therapy, and mental health care, feature copays ranging from $0 to $50 and no coinsurance, though chiropractic services are only partially covered as other chiropractic services are not covered.
Preventive Services See details
AARP Medicare Advantage from UHC WA-16 (PPO) partially covers preventive services with no copay and no coinsurance for annual physicals, kidney disease education, fitness benefits, and select screenings. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC WA-16 (PPO), offering routine hearing exams with no copay and no coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids (up to 2 yearly) require a $199 to $1,249 copay and no coinsurance, while OTC hearing aids cost a $199 to $829 copay and no coinsurance, but 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 WA-16 (PPO) with no coinsurance, offering a $0 copay for one routine annual eye exam and a $300 combined eyewear allowance every two years. Covered eyewear includes contact lenses and frames with no copay, and eyeglass lenses with a $0 to $153 copay, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered under the AARP Medicare Advantage from UHC WA-16 (PPO) plan, which features a $1,000 annual benefit limit. Diagnostic and preventive services have no copay and no coinsurance, Medicare-covered services require no copay and 20% coinsurance, and comprehensive services require no copay and 50% coinsurance, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC WA-16 (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs have a $35 copay and up to 20% coinsurance.
Dialysis Services See details
AARP Medicare Advantage from UHC WA-16 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by AARP Medicare Advantage from UHC WA-16 (PPO) with no copay, though a 20% coinsurance applies to durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are covered with no copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the AARP Medicare Advantage from UHC WA-16 (PPO), with prior authorization required. Members pay no copay and no coinsurance for lab services and diagnostic radiological services, a $55 copay and no coinsurance for diagnostic procedures, a $30 copay for outpatient X-rays, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by the AARP Medicare Advantage from UHC WA-16 (PPO) plan 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 WA-16 (PPO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC WA-16 (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the standard 100-day limit are not covered.
Other Services See details
AARP Medicare Advantage from UHC WA-16 (PPO) partially covers other services, offering acupuncture with a $10.00 copay and no coinsurance for up to 12 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Over-the-Counter (OTC) items are not covered under this plan.
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