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AARP Medicare Advantage from UHC NC-0016 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NC-0016 (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 NC-0016 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC NC-0016 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in North Carolina. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage from UHC NC-0016 (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 NC-0016 (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 NC-0016 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $53.00. 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 $520.00 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 $6300.00 (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 $6300.00 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 NC-0016 (PPO) plan features an annual drug deductible of $520. For Tier 1 preferred generic drugs, there is no copay for 1-month and 3-month supplies at standard pharmacies, or for 3-month mail-order fills. Tier 2 generic medications carry an $8 copay for a 1-month standard pharmacy supply, but you can access a 3-month supply with no copay through preferred mail order. Higher-tier medications under this plan utilize coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 15% coinsurance across standard pharmacy and mail-order options. Tier 4 non-preferred drugs carry a 42% coinsurance, while Tier 5 specialty drugs require a 27% coinsurance for 1-month supplies.
Additional Benefits
The AARP Medicare Advantage from UHC NC-0016 (PPO) plan offers comprehensive coverage for essential healthcare, featuring no copays or coinsurance for primary care and telehealth visits. Specialist visits, physical therapy, and diagnostic lab services require low copays, with no copay for many covered services. Inpatient hospital stays require a $395 daily copay for days one through six and no copay for days seven through ninety, while emergency room visits carry a $150 copay that is waived upon admission. For supplemental care, the plan provides robust dental benefits up to a $2,500 annual limit with no copay for preventive services, alongside a $300 eyewear allowance every two years and no copay for routine vision and hearing exams. Durable medical equipment, prosthetics, and dialysis services are covered with no copay and a 20% coinsurance. Furthermore, home health services and skilled nursing facility stays for the first twenty days are covered with no copay.
Inpatient Hospital See details
AARP Medicare Advantage from UHC NC-0016 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $395 daily copay for days 1 to 6 and no copay for days 7 to 90 for both acute and psychiatric stays. Unlimited additional acute days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by AARP Medicare Advantage from UHC NC-0016 (PPO) with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from no copay to $395, while outpatient substance abuse sessions carry a copay of up to $25.
Partial Hospitalization See details
AARP Medicare Advantage from UHC NC-0016 (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 NC-0016 (PPO) covers ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage from UHC NC-0016 (PPO) with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services have a copay ranging from no copay to $65 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Primary care benefits for the AARP Medicare Advantage from UHC NC-0016 (PPO) plan feature primary care physician and telehealth visits with no copay and no coinsurance. Specialist visits, physical therapy, and mental health services are covered with copays ranging from $0 to $40 and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by AARP Medicare Advantage from UHC NC-0016 (PPO) with no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and kidney disease education. However, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and in-home support.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC NC-0016 (PPO) with no deductible and no coinsurance. Routine exams have no copay, prescription hearing aids require a $199 to $1,249 copay, and OTC hearing aids require a $199 to $829 copay, but fitting and evaluation exams along with inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by AARP Medicare Advantage from UHC NC-0016 (PPO), featuring no copay and no coinsurance for one routine eye exam per year, though other eye exam services are not covered. Eyewear is covered up to a $300 combined limit every two years with no coinsurance, offering contact lenses and frames with no copay and eyeglass lenses with a $0 to $153 copay, while upgrades and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage from UHC NC-0016 (PPO) partially covers dental services up to a $2,500 annual limit, though implant services and orthodontics are not covered. Preventive and diagnostic services are available with no copay and no coinsurance, while Medicare-covered dental services require a 20% coinsurance and covered comprehensive services require a 50% coinsurance, both with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by AARP Medicare Advantage from UHC NC-0016 (PPO) with no copay, though prior authorization is required. While there is no copay for the administration service itself, associated Medicare Part B drugs—including chemotherapy, insulin, and other infusion drugs—require a coinsurance ranging from no coinsurance up to 20%, with insulin specifically carrying a $35 copay.
Dialysis Services See details
Dialysis services are covered by the AARP Medicare Advantage from UHC NC-0016 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
AARP Medicare Advantage from UHC NC-0016 (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage from UHC NC-0016 (PPO) with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic procedures require a $5 copay, outpatient X-rays cost $10, therapeutic radiology has a $40 copay, and diagnostic radiology copays start at $0.
Home Health Services See details
AARP Medicare Advantage from UHC NC-0016 (PPO) 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 under the AARP Medicare Advantage from UHC NC-0016 (PPO) plan with no copay and no coinsurance, although only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC NC-0016 (PPO) covers Skilled Nursing Facility (SNF) services with prior authorization and no coinsurance, requiring no prior three-day inpatient hospital stay. Under this plan, there is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
AARP Medicare Advantage from UHC NC-0016 (PPO) partially covers Other Services, offering a meal benefit for chronic illnesses with no copay and no coinsurance, though prior authorization is required. Acupuncture and Over-the-Counter (OTC) items are not covered under this benefit.
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