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AARP Medicare Advantage from UHC HI-0004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC HI-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 HI-0004 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage from UHC HI-0004 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Hawaii County. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that AARP Medicare Advantage from UHC HI-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 HI-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 HI-0004 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.00. 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 $420.00 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 HI-0004 (PPO) plan has an enhanced alternative drug benefit. The plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay a copay for your prescriptions. For example, you will pay a $12 copay for preferred generic drugs at a standard pharmacy. For preferred brand drugs, you will pay a $100 copay. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The AARP Medicare Advantage from UHC HI-0004 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays between $0-$425. Emergency services have a copay, and both primary care and preventive services are covered, often with no copay. The plan also covers hearing and vision services, with no copay for hearing exams and eye exams. Dental services, home infusion, and dialysis are covered, with some services requiring coinsurance. Additionally, the plan provides benefits for home health, skilled nursing facilities, and other services like acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for both acute and psychiatric care. For acute care, you'll pay a $425 copay for days 1-6, and no copay for days 7-90, with additional days covered with no copay. Psychiatric care also has a $425 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $0-$425, observation services with a copay of $425, and ambulatory surgical center services with no copay. Also covered are individual outpatient substance abuse sessions with a copay of $0-$25, and group sessions with a copay of $15, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the AARP Medicare Advantage from UHC HI-0004 (PPO) plan. Both ground and air ambulance services have a copay of $275, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the AARP Medicare Advantage from UHC HI-0004 (PPO) plan with a $125 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $55, and no coinsurance. Worldwide Emergency Services are also covered, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay and no coinsurance.
Primary Care See details
The AARP Medicare Advantage from UHC HI-0004 (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $10 copay, Occupational Therapy Services with a copay between $0 and $40, Physician Specialist Services with a copay between $0 and $40, and Mental Health Specialty Services with a copay between $0 and $25 for individual sessions and $15 for group sessions. The plan also covers Podiatry Services with a $40 copay, Other Health Care Professional services with a copay between $0 and $40, Psychiatric Services with a copay between $0 and $25 for individual sessions and $15 for group sessions, Physical Therapy and Speech-Language Pathology Services with a copay between $0 and $40, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional services like fitness benefits, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with no copay. Other services like health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing exams are covered with no copay, including routine hearing exams. Prescription hearing aids are covered, with a copay between $199 and $1249, depending on the type of hearing aid. OTC hearing aids are covered with a copay between $99 and $829.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered annually. Eyewear benefits include contact lenses, eyeglass lenses, and eyeglass frames, each with no copay; contact lenses are unlimited, but eyeglass lenses and frames are limited to one every two years, and there is a combined maximum benefit of $200 for all eyewear every two years. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. Restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, and oral and maxillofacial surgery have no copay, while prosthodontics (removable and fixed) has a coinsurance of 0% - 50%. However, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the AARP Medicare Advantage from UHC HI-0004 (PPO) plan, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. You will pay a $35 copay for Medicare Part B Insulin Drugs, and the coinsurance for all the drugs can range from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the AARP Medicare Advantage from UHC HI-0004 (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance. Diabetic Equipment is covered, with Medicare-covered Diabetic Supplies having no copay, and Medicare-covered Diabetic Therapeutic Shoes or Inserts having 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic Procedures/Tests have a $50 copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $250, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage from UHC HI-0004 (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, but the plan does not cover the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the AARP Medicare Advantage from UHC HI-0004 (PPO) plan, requiring prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203 per day. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with a $10 copay per visit, with a limit of 12 treatments per year, and meal benefits with no copay. Over-the-counter items, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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.
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