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AARP Medicare Advantage Essentials from UHC EP-1 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage Essentials from UHC EP-1 (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 Essentials from UHC EP-1 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage Essentials from UHC EP-1 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Texas and New Mexico. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that AARP Medicare Advantage Essentials from UHC EP-1 (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 Essentials from UHC EP-1 (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 Essentials from UHC EP-1 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $340.00 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 $6200.00 (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 $6200.00 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 Essentials from UHC EP-1 (PPO) plan has an enhanced alternative drug benefit. The plan has a $340 deductible. In the initial coverage phase, after the deductible, you will pay a copay for your prescriptions. For preferred generic drugs at a standard pharmacy, the copay is $14.00. Standard generic drugs have a $47.00 copay. Preferred and standard brand drugs have a $100.00 copay. Non-preferred drugs have a 29% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The AARP Medicare Advantage Essentials from UHC EP-1 (PPO) plan offers coverage for a wide range of services. This plan provides inpatient hospital care with a $225 copay for the first five days, and no copay for the rest of the benefit period. Outpatient services, including primary care, have copays that vary from $0 to $35 depending on the service. Preventive services, vision and hearing exams, and dental services are covered under the plan, with no copay for eye exams and a 20% coinsurance for dental services. The plan also covers ambulance services with a $215 copay, emergency services with a $140 copay, and offers additional benefits like home health services with no copay, and over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $225 copay for days 1-5, and no copay for days 6-90, and additional days 91-999 have no copay; Inpatient Hospital Psychiatric has a $225 copay for days 1-5, and no copay for days 6-90, while additional days are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $225, Observation Services have a $225 copay, Ambulatory Surgical Center Services have no copay, and Outpatient Blood Services have no copay. Individual sessions for Outpatient Substance Abuse have a copay between $0 and $25, while group sessions have a $15 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the AARP Medicare Advantage Essentials from UHC EP-1 (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the AARP Medicare Advantage Essentials from UHC EP-1 (PPO) plan. Both ground and air ambulance services have a $215 copay, with no coinsurance, 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 Essentials from UHC EP-1 (PPO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a copay of $0-$60; 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 includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $0-$25 copay, Physician Specialist Services with a $0-$35 copay, Mental Health Specialty Services with a $0-$25 copay for individual sessions and a $15 copay for group sessions, Podiatry Services with a $35 copay, Other Health Care Professional with a $0-$35 copay, Psychiatric Services with a $0-$25 copay for individual sessions and a $15 copay for group sessions, Physical Therapy and Speech-Language Pathology Services with a $0-$25 copay, 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 are covered, including an annual physical exam with no copay. Additional preventive services include fitness benefits and home and bathroom safety devices and modifications, both with no copay, but other services like health education and counseling services are not covered. Other covered services, such as glaucoma screenings and diabetes self-management training, have no copay.
Hearing Services See details
Hearing exams are covered with no copay. Prescription hearing aids (all types) are covered with a copay between $199 and $1249, and over-the-counter hearing aids are covered with a copay between $99 and $829. Fitting/evaluation for hearing aids, and prescription hearing aids - inner and outer ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear has no copay, and includes contact lenses, eyeglass lenses, and eyeglass frames. Eyeglasses (lenses and frames) and upgrades are not covered, and there is a combined maximum benefit of $200 for all eyewear every two years.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay, but other services like orthodontics, restorative services, and more are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered with prior authorization. For Medicare Part B Insulin Drugs, you pay a $35 copay and between 0-20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you pay between 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage Essentials from UHC EP-1 (PPO) plan, with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $25 copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $100, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with a $15 copay.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage Essentials from UHC EP-1 (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 under the AARP Medicare Advantage Essentials from UHC EP-1 (PPO) plan, but all specific cardiac rehabilitation services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with a $0 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
Under the "Other Services" benefit, acupuncture, 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, 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. Over-the-counter (OTC) items and Meal Benefit are covered with a $0 copay.
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