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AARP Medicare Advantage from UHC NM-0004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NM-0004 (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-0004 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC NM-0004 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Albuquerque Metro Area. 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-0004 (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-0004 (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-0004 (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 $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 NM-0004 (PPO) plan features an annual drug deductible of $600. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies, or for 3-month mail orders. Tier 2 generic drugs cost just a $2.00 copay for a 1-month supply at standard pharmacies, while a 3-month supply through preferred mail order has no copay. For higher-tier medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance for both standard pharmacy and mail order fills. Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 27% and 26% coinsurance respectively for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC NM-0004 (PPO) plan offers robust coverage for essential medical services, featuring no copays and no coinsurance for primary care visits, home health care, and covered preventive services. For inpatient hospital stays, members pay a $550 copay per day for the first five days and no copay for subsequent days, while emergency care carries a $130 copay that is waived if admitted. Specialist visits and outpatient services generally require low to moderate copays with no coinsurance, making day-to-day healthcare expenses highly predictable. Routine dental, vision, and hearing exams are covered with no copay, though prescription hearing aids and eyeglass lenses require copays, and comprehensive dental services are not covered. Skilled nursing facility care features no copay for the first 20 days, followed by a $218 daily copay up to day 100. Durable medical equipment and dialysis services require a 20% coinsurance with no copay, ensuring reliable coverage for specialized medical needs.
Inpatient Hospital See details
AARP Medicare Advantage from UHC NM-0004 (PPO) covers inpatient acute hospital stays with no coinsurance and a $550 copay for days 1 to 5, and no copay for days 6 and beyond. Inpatient psychiatric stays are covered with no coinsurance and a $550 copay for days 1 to 4, but additional psychiatric days, hospital upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services covered by the AARP Medicare Advantage from UHC NM-0004 (PPO) feature no coinsurance, with copays ranging from no copay for ambulatory surgical center and blood services up to $550 per day for outpatient hospital and observation services. Outpatient substance abuse sessions are also covered with no coinsurance and copays ranging from $0 to $25, with prior authorization required for most services.
Partial Hospitalization See details
AARP Medicare Advantage from UHC NM-0004 (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC NM-0004 (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance per service, which requires prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
AARP Medicare Advantage from UHC NM-0004 (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 of $0 to $50 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 from UHC NM-0004 (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require no coinsurance and copays ranging from $0 to $40. Chiropractic services are partially covered, with routine and other chiropractic services not covered under the plan.
Preventive Services See details
Preventive Services are partially covered by AARP Medicare Advantage from UHC NM-0004 (PPO) with no copay and no coinsurance for covered options like annual physical exams, fitness benefits, home safety devices, kidney disease education, and various health screenings. Services not covered under this plan include health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC NM-0004 (PPO), featuring one annual routine hearing exam with no copay and no coinsurance, though fitting and evaluation exams are not covered. The plan also covers up to two prescription or OTC hearing aids per year with no coinsurance and copays ranging from $199 to $1,249, 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 NM-0004 (PPO) with no deductible, no coinsurance, and no copay for annual routine eye exams, contact lenses, and eyeglass frames. Eyeglass lenses have a copay of $0 to $153, eyewear features a combined $150 maximum benefit every two years, and other eye exams, upgrades, and combined eyeglasses are not covered.
Dental Services See details
Dental services are partially covered under the AARP Medicare Advantage from UHC NM-0004 (PPO) plan, with preventive care such as exams, cleanings, and x-rays requiring no copay and no coinsurance, and Medicare-covered dental services requiring no copay and a 20% coinsurance. Comprehensive services, including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by AARP Medicare Advantage from UHC NM-0004 (PPO) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
AARP Medicare Advantage from UHC NM-0004 (PPO) covers dialysis services with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
AARP Medicare Advantage from UHC NM-0004 (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with coverage limited to specified manufacturers.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC NM-0004 (PPO) covers diagnostic and radiological services, with prior authorization required for most services. Lab services and diagnostic radiology feature no copay and no coinsurance, while diagnostic tests cost a $50 copay with no coinsurance, outpatient X-rays require a $30 copay plus coinsurance, and therapeutic radiology requires a copay and 20% coinsurance.
Home Health Services See details
The AARP Medicare Advantage from UHC NM-0004 (PPO) plan covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by AARP Medicare Advantage from UHC NM-0004 (PPO) with no copay and no coinsurance, subject to prior authorization. However, key sub-services are not covered in practice, including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by AARP Medicare Advantage from UHC NM-0004 (PPO) with no coinsurance and does not require a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
AARP Medicare Advantage from UHC NM-0004 (PPO) partially covers other services, providing over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires prior authorization.
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