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AARP Medicare Advantage from UHC NM-0005 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NM-0005 (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-0005 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC NM-0005 (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-0005 (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-0005 (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-0005 (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-0005 (PPO) plan features an annual drug deductible of $600. Tier 1 preferred generic drugs offer savings with no copay for 1-month and 3-month supplies at standard pharmacies, as well as no copay for 3-month mail orders. 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 shift to coinsurance during the initial coverage phase. Tier 3 preferred brand drugs carry a 19% coinsurance for both standard pharmacies and mail-order options. Tier 4 non-preferred drugs require a 27% coinsurance for a 1-month supply, while Tier 5 specialty drugs have a 26% coinsurance across standard pharmacies and mail-order channels.
Additional Benefits
The AARP Medicare Advantage from UHC NM-0005 (PPO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care visits, annual physicals, and home health services. For hospital stays, members pay a $550 copay for the first few days of inpatient care, while emergency room visits carry a $130 copay that is waived if admitted. Outpatient services and diagnostics feature no copay for lab work and ambulatory surgery, while specialist visits range from no copay to a $50 copay. Routine vision, hearing, and preventive dental services are covered with no copay and no coinsurance, though copays apply for prescription hearing aids and comprehensive dental care is excluded. For major medical needs, dialysis, durable medical equipment, and certain Part B drugs require a 20% coinsurance with no copay. Skilled nursing facility care is also available with no copay for the first 20 days, followed by a $218 daily copay for days 21 to 100.
Inpatient Hospital See details
Inpatient hospital services are partially covered by AARP Medicare Advantage from UHC NM-0005 (PPO) with no coinsurance, though prior authorization is required and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays require a $550 copay for days 1 to 5 (no copay for days 6 and beyond), while psychiatric stays require a $550 copay for days 1 to 4 (no copay for days 5 to 90).
Outpatient Services See details
AARP Medicare Advantage from UHC NM-0005 (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services carry copays ranging from $0 to $550, while outpatient substance abuse sessions have copays up to $25.
Partial Hospitalization See details
AARP Medicare Advantage from UHC NM-0005 (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by AARP Medicare Advantage from UHC NM-0005 (PPO). Medicare-approved ground and air ambulance services require prior authorization and have a $275 copay with no coinsurance, while routine transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage from UHC NM-0005 (PPO) with a $130 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services have a copay ranging from $0 to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are fully covered with no copay and no coinsurance.
Primary Care See details
AARP Medicare Advantage from UHC NM-0005 (PPO) offers primary care and telehealth services with no copay and no coinsurance. Specialist visits range from a $0 to $50 copay, physical and occupational therapies require a $40 copay, and mental health services have a $0 to $25 copay, all with no coinsurance. While some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
AARP Medicare Advantage from UHC NM-0005 (PPO) provides partially covered preventive services with no copay and no coinsurance for covered care, including annual physical exams, fitness benefits, and kidney disease education. However, several supplemental benefits are not covered under this plan, such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and counseling.
Hearing Services See details
AARP Medicare Advantage from UHC NM-0005 (PPO) covers 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 hearing aids per year with copays ranging from $199 to $1,249, and up to two OTC hearing aids with copays from $199 to $829, both with no coinsurance, though inner, outer, and over-the-ear prescription aids are excluded.
Vision Services See details
Vision Services are partially covered by AARP Medicare Advantage from UHC NM-0005 (PPO), featuring one routine eye exam per year with no copay and no coinsurance. Eyewear is covered up to a $150 combined limit every two years with no coinsurance, offering no copay for contact lenses and frames, and a $0 to $153 copay for lenses, though other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental Services are partially covered under the AARP Medicare Advantage from UHC NM-0005 (PPO) plan, offering preventive care like exams, cleanings, x-rays, and fluoride with no copay and no coinsurance. Medicare-covered dental services are available with no copay and a 20% coinsurance, but comprehensive services—including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics—are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC NM-0005 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry no copay and 0% (no coinsurance) to 20% coinsurance, while covered Part B insulin has a $35 copay and 0% (no coinsurance) to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage from UHC NM-0005 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
AARP Medicare Advantage from UHC NM-0005 (PPO) covers 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 require 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC NM-0005 (PPO) covers diagnostic and radiological services, with prior authorization required. Members pay no copay or coinsurance for lab services and diagnostic radiology, a $45 copay with no coinsurance for diagnostic tests, a $30 copay for outpatient X-rays, and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by AARP Medicare Advantage from UHC NM-0005 (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 from UHC NM-0005 (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC NM-0005 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no prior three-day hospital stay but requiring prior authorization. There is no copay for days 1 to 20 and a $218 daily copay for days 21 to 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
AARP Medicare Advantage from UHC NM-0005 (PPO) partially covers other services, offering over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for the meal benefit, and acupuncture is not covered.
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