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AARP Medicare Advantage from UHC NM-0003 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NM-0003 (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 NM-0003 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC NM-0003 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in New Mexico. 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 NM-0003 (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 NM-0003 (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 NM-0003 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.00. 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 $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 NM-0003 (PPO) plan features an annual drug deductible of $520. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and mail-order services. Tier 2 generic drugs cost a $10 copay for a 1-month supply at standard pharmacies, but you can receive a 3-month supply with no copay through preferred mail order. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs carry a 17% coinsurance, while Tier 4 non-preferred drugs require 32% coinsurance for a 1-month supply. Tier 5 specialty drugs require a 27% coinsurance at standard pharmacies and through mail order.
Additional Benefits
The AARP Medicare Advantage from UHC NM-0003 (PPO) plan offers comprehensive medical coverage featuring no copay for primary care visits, annual physicals, and home health services. For specialist visits, members pay a low copay ranging from $0 to $50, while inpatient hospital stays require a $445 copay for the first few days with no copay thereafter. Emergency room visits carry a $130 copay with no coinsurance, which is waived if you are admitted to the hospital within 24 hours. This plan also includes valuable extra benefits like routine dental, vision, and hearing care, featuring no copays for routine eye exams, routine hearing exams, and preventive dental care up to a $1,500 annual limit. Prescription hearing aids require copays starting at $199, while durable medical equipment and dialysis services generally require a 20% coinsurance with no copay. Additionally, members can take advantage of a $150 eyewear allowance every two years and no copays for over-the-counter items and chronic illness meal benefits.
Inpatient Hospital See details
Inpatient hospital services are covered by AARP Medicare Advantage from UHC NM-0003 (PPO) with no coinsurance, requiring a $445 copay for days 1 through 6 of acute stays (no copay for days 7 and beyond) and a $445 copay for days 1 through 5 of psychiatric stays (no copay for days 6 through 90). This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by AARP Medicare Advantage from UHC NM-0003 (PPO) with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of up to $445 with no coinsurance, while outpatient substance abuse services have copays ranging from no copay up to $25 with no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the AARP Medicare Advantage from UHC NM-0003 (PPO) with a $55.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC NM-0003 (PPO) covers ground and air ambulance services with a $290 copay and no coinsurance, requiring prior authorization. For transportation services, some services are covered but transportation to plan-approved locations and any health-related locations is not covered.
Emergency Services See details
AARP Medicare Advantage from UHC NM-0003 (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 have a copay ranging from $0 to $50 with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no copays or coinsurance.
Primary Care See details
AARP Medicare Advantage from UHC NM-0003 (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $50 copay and no coinsurance. Therapy services, including physical and occupational, have a $45 copay and no coinsurance, but chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are covered by AARP Medicare Advantage from UHC NM-0003 (PPO) with no copays and no coinsurance for annual physicals, kidney disease education, and select screenings. While fitness benefits and home safety devices are also covered at no cost, this benefit is only partially covered, excluding services such as health education, weight management, and personal emergency response systems.
Hearing Services See details
Hearing Services are partially covered by AARP Medicare Advantage from UHC NM-0003 (PPO), featuring routine hearing exams with no copay and no coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids have a $199.00 to $1,249.00 copay and OTC hearing aids have a $199.00 to $829.00 copay, both with no coinsurance, but inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered under the AARP Medicare Advantage from UHC NM-0003 (PPO) plan, featuring no deductibles, no coinsurance, and no copays for routine eye exams and select eyewear. Covered benefits include one routine eye exam per year and a $150 combined eyewear allowance every two years for contact lenses, eyeglass frames, and eyeglass lenses (with copays ranging from $0 to $153), while other eye exams, combined eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Dental services are partially covered by AARP Medicare Advantage from UHC NM-0003 (PPO), excluding implant services and orthodontics. Preventive care is offered with no copay and no coinsurance up to a $1,500 yearly limit, while covered comprehensive services require no copay and a 50% coinsurance, and Medicare-covered dental services have no copay and a 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the AARP Medicare Advantage from UHC NM-0003 (PPO) with no copay, although prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by AARP Medicare Advantage from UHC NM-0003 (PPO) 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 NM-0003 (PPO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay, though manufacturer limits and prior authorization requirements apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage from UHC NM-0003 (PPO) with no coinsurance, though prior authorization is required. There is no copay for lab services, a $25 copay for diagnostic tests and outpatient X-rays, a $0 minimum copay for diagnostic radiology, and a minimum $80 copay for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage from UHC NM-0003 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under AARP Medicare Advantage from UHC NM-0003 (PPO) require prior authorization and feature no copay and no coinsurance. In practice, some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC NM-0003 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no prior three-day hospital stay, although prior authorization is necessary. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
AARP Medicare Advantage from UHC NM-0003 (PPO) offers partial coverage for other services, providing over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and other additional services are not covered under this benefit.
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