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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 2026, 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 New Mexico and Texas. This plan received an overall rating of 4 out of 5 stars in 2026.
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 $440.00 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 Essentials from UHC EP-1 (PPO) plan features an annual drug deductible of $440. For Tier 1 preferred generic drugs, there is no copay for 1-month or 3-month standard pharmacy fills, as well as 3-month mail-order fills. Tier 2 generic drugs carry a $14 copay for a 1-month standard pharmacy supply, but you pay no copay for a 3-month supply filled through preferred mail order. Higher-tier medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 15% coinsurance, while Tier 4 non-preferred drugs carry a 35% coinsurance. Specialty drugs under Tier 5 require a 28% coinsurance for a 1-month supply through standard pharmacies or mail order.
Additional Benefits
The AARP Medicare Advantage Essentials from UHC EP-1 (PPO) plan offers affordable access to core medical services, featuring no copays and no coinsurance for primary care visits, annual physicals, and home health care. Specialist visits require no coinsurance with copays up to $45, while inpatient hospital stays have a $345 daily copay for the first six days and no copay for remaining days. Emergency services are covered with a $150 copay, and urgent care visits carry a copay of up to $65. Routine vision exams, annual hearing tests, and preventive dental cleanings are fully covered with no copay and no coinsurance. Prescription hearing aids and eyeglasses are partially covered, while medical equipment, diabetic shoes, and dialysis services require a 20% coinsurance. It is important to note that this plan does not cover transportation, cardiac rehabilitation, or comprehensive dental procedures like root canals and implants.
Inpatient Hospital See details
AARP Medicare Advantage Essentials from UHC EP-1 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $345 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage Essentials from UHC EP-1 (PPO) covers outpatient services with no coinsurance, although prior authorization is required for most services. Outpatient hospital services carry a copay of $0 to $345, outpatient substance abuse services have copays between $0 and $25, and there is no copay for ambulatory surgical center or blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by the AARP Medicare Advantage Essentials from UHC EP-1 (PPO) plan with a $55 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
AARP Medicare Advantage Essentials from UHC EP-1 (PPO) covers ground and air ambulance services with a $275 copay per trip and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
AARP Medicare Advantage Essentials from UHC EP-1 (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature a copay ranging from $0 to $65 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
AARP Medicare Advantage Essentials from UHC EP-1 (PPO) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance, while chiropractic services are not covered. Other covered services, including specialist visits, therapy, and mental health services, require no coinsurance and feature copays ranging from $0 to $45.
Preventive Services See details
Preventive Services under the AARP Medicare Advantage Essentials from UHC EP-1 (PPO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. This benefit is partially covered because while fitness benefits and home safety devices are included at no cost, several sub-services such as health education, personal emergency response systems, and nutritional/dietary benefits are not covered.
Hearing Services See details
AARP Medicare Advantage Essentials from UHC EP-1 (PPO) provides partially covered hearing services, including one annual routine exam with no copay and no coinsurance, plus prescription hearing aids with a $199.00 to $1,249.00 copay and OTC hearing aids with a $199.00 to $829.00 copay, both with no coinsurance. Hearing aid fittings and evaluations, along with inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
AARP Medicare Advantage Essentials from UHC EP-1 (PPO) partially covers vision services with no deductible, no coinsurance, and no copay for routine eye exams, contact lenses, and frames. Eyeglass lenses have a copay ranging from $0 to $153 under a $150 combined eyewear limit every two years, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by AARP Medicare Advantage Essentials from UHC EP-1 (PPO), which offers preventive care like exams and cleanings with no copay and no coinsurance. Medicare-covered dental services are available with no copay and a 20% coinsurance, but comprehensive treatments such as restorative services, endodontics, periodontics, prosthodontics, implants, orthodontics, and oral surgery are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage Essentials from UHC EP-1 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Part B drugs, including chemotherapy and other infusion drugs, require no coinsurance to 20% coinsurance, while covered insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
AARP Medicare Advantage Essentials from UHC EP-1 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
AARP Medicare Advantage Essentials from UHC EP-1 (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, and diabetic therapeutic shoes or inserts are covered with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the AARP Medicare Advantage Essentials from UHC EP-1 (PPO) plan, with lab services requiring no copay or coinsurance and diagnostic tests carrying a $50 copay with no coinsurance. Diagnostic radiology copays start at $0, outpatient X-rays require a $30 copay, and therapeutic radiology requires a 20% coinsurance, with prior authorization required for these services.
Home Health Services See details
Home health services are covered by the AARP Medicare Advantage Essentials from UHC EP-1 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the AARP Medicare Advantage Essentials from UHC EP-1 (PPO) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the AARP Medicare Advantage Essentials from UHC EP-1 (PPO) with no coinsurance, requiring no copay for days 1 to 20 and a $218 copay per day for days 21 to 100. Prior authorization is required, a 3-day prior hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by AARP Medicare Advantage Essentials from UHC EP-1 (PPO), as acupuncture is not covered. Eligible members can receive over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, though prior authorization is required for the meal benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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