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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 2026, 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 2026.
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 $54.00. 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 HI-0004 (PPO) plan features an annual drug deductible of $600. Tier 1 preferred generic drugs offer excellent savings with no copay for 1-month or 3-month fills at standard pharmacies and mail-order services. Tier 2 generic drugs cost a $12 copay for a 1-month standard pharmacy supply, though you can secure a 3-month supply with no copay through preferred mail order. Brand-name and specialty medications under this plan are covered via coinsurance. Tier 3 preferred brand drugs require a 21% coinsurance for 1-month and 3-month fills at standard pharmacies and mail order. Tier 4 non-preferred drugs incur a 28% coinsurance, while Tier 5 specialty drugs require a 26% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC HI-0004 (PPO) plan offers robust coverage for core medical services, featuring no copay for primary care visits, annual physicals, and home health services. For inpatient hospital stays, members pay no coinsurance and a $685 copay for days one through three, with no copay for subsequent days. Outpatient care, diagnostic labs, and routine screenings also feature no coinsurance, with most specialist visits and diagnostic tests requiring low copays of $50 or less. Routine vision and hearing exams are available with no copay, and the plan covers prescription hearing aids and eyewear with no coinsurance. Preventive dental care is fully covered with no copay, while Medicare-covered dental services, dialysis, and durable medical equipment require a 20% coinsurance. Other key benefits include covered home infusion services, a chronic illness meal benefit with no copay, and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
AARP Medicare Advantage from UHC HI-0004 (PPO) covers inpatient hospital services with no coinsurance, requiring a $685 copayment for days 1 through 3 and no copayment for days 4 and beyond. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC HI-0004 (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $685, while outpatient substance abuse services require a copay of $0 to $25 for individual sessions and a $15 copay for group sessions.
Partial Hospitalization See details
AARP Medicare Advantage from UHC HI-0004 (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 services are covered by AARP Medicare Advantage from UHC HI-0004 (PPO) with a $275.00 copay and no coinsurance for both ground and air services, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage from UHC HI-0004 (PPO) with a $130 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $0 to $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copays and no coinsurance.
Primary Care See details
Primary care benefits under the AARP Medicare Advantage from UHC HI-0004 (PPO) plan are covered with no coinsurance, offering no copay for primary care visits, telehealth, and opioid treatment. Copays for specialists, mental health, podiatry, and physical, occupational, or speech therapies range from $0 to $50, though chiropractic services are only partially covered as routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered under the AARP Medicare Advantage from UHC HI-0004 (PPO) plan, offering no copay and no coinsurance for covered benefits such as annual physicals, fitness benefits, kidney education, and select screenings. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, 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 benefits, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
AARP Medicare Advantage from UHC HI-0004 (PPO) provides partially covered hearing services, offering one annual routine hearing exam with no copay and no coinsurance, though fitting and evaluation exams are not covered. Prescription and OTC hearing aids are covered for up to two devices per year with no coinsurance and copays ranging from $199.00 to $1,249.00, 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 HI-0004 (PPO), featuring no coinsurance and no copay for annual routine eye exams, alongside eyewear coverage with no coinsurance and copays ranging from $0 to $153 up to a $200 limit every two years. Other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental Services are partially covered by AARP Medicare Advantage from UHC HI-0004 (PPO), which features Medicare-covered dental services with no copay and 20% coinsurance, and preventive services with no copay and no coinsurance. However, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC HI-0004 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, 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
Dialysis services are covered by AARP Medicare Advantage from UHC HI-0004 (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by AARP Medicare Advantage from UHC HI-0004 (PPO), featuring no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage from UHC HI-0004 (PPO) with no coinsurance, though prior authorization is required. Outpatient X-rays and diagnostic tests have a $5 copay, therapeutic radiology has a $30 copay, and there is no copay for lab services and diagnostic radiological services.
Home Health Services See details
AARP Medicare Advantage from UHC HI-0004 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the AARP Medicare Advantage from UHC HI-0004 (PPO) plan are structured so that some services are covered with no copay and no coinsurance, but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC HI-0004 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no 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 additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by AARP Medicare Advantage from UHC HI-0004 (PPO), featuring a meal benefit for chronic illnesses with no copay and no coinsurance, although prior authorization is required. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered.
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