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AARP Medicare Advantage Giveback from UHC NM-7 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage Giveback from UHC NM-7 (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 Giveback from UHC NM-7 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage Giveback from UHC NM-7 (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 2025.
It's important to know that AARP Medicare Advantage Giveback from UHC NM-7 (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 Giveback from UHC NM-7 (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 Giveback from UHC NM-7 (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. Additionally, this plan comes with a Part B Premium reduction of $46.00. You must continue to pay paying your reduced 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 $405.00 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 Giveback from UHC NM-7 (PPO) plan has a $405.00 deductible for prescription drugs. After meeting your deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you will pay a $0 copay for preferred generic drugs at a standard pharmacy, $47.00 for standard generic drugs, and $100.00 for preferred brand drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The AARP Medicare Advantage Giveback from UHC NM-7 (PPO) plan offers a wide range of benefits with varying cost-sharing. The plan includes no copay for primary care visits, preventive services, hearing exams, eye exams, and home health services. Additionally, the plan offers coverage for inpatient and outpatient services, vision and dental services, and prescription drugs. This plan has copays for some services, such as hospital stays, specialist visits, and ambulance services. Other benefits include coverage for medical equipment, diagnostic services, and skilled nursing facilities. However, some services like cardiac rehabilitation, private duty nursing, and certain dental procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $425 copay for days 1-7, and no copay for days 8-90, and no copay for days 91-999. For Inpatient Hospital Psychiatric, you will pay a $425 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $425, observation services with a $425 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services include individual sessions with a copay between $0 and $25 and group sessions with a $15 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the AARP Medicare Advantage Giveback from UHC NM-7 (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AARP Medicare Advantage Giveback from UHC NM-7 (PPO) plan. Ground and Air Ambulance Services have a $225 copay, and there is no coinsurance, but Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the AARP Medicare Advantage Giveback from UHC NM-7 (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $55; Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The AARP Medicare Advantage Giveback from UHC NM-7 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a copay between $0 and $45. The plan also covers physician specialist services with a copay between $0 and $55, and mental health specialty services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions. Additionally, the plan covers podiatry services with a $45 copay, other healthcare professional services with a copay between $0 and $55, psychiatric services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, and physical therapy and speech-language pathology services with a copay between $0 and $45. The plan also covers 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 preventive services, kidney disease education services, and other preventive services are also covered, and may have a copay. Some specific services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
The AARP Medicare Advantage Giveback from UHC NM-7 (PPO) plan covers hearing exams with no copay. Routine hearing exams are covered with no copay for 1 visit every year, while fitting/evaluation for hearing aids is not covered. Prescription hearing aids are partially covered, with a copay between $199 and $1249 for 2 visits every year for all types, while inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered with a copay between $99 and $829 for 2 hearing aids every year.
Vision Services See details
Vision Services includes eye exams and eyewear coverage. Eye exams have no copay, and eyewear has a combined maximum of $200 every two years, with no copay for contact lenses and eyeglass frames, and a copay of $0-$153 for eyeglass lenses.
Dental Services See details
Dental services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with no details provided. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay. Orthodontic, restorative, adjunctive general, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the AARP Medicare Advantage Giveback from UHC NM-7 (PPO) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the AARP Medicare Advantage Giveback from UHC NM-7 (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance with no copay for Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a $50 copay, and lab services with 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 Giveback from UHC NM-7 (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the AARP Medicare Advantage Giveback from UHC NM-7 (PPO) plan. Prior authorization is required for these services, but the plan does not cover the cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, or SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under this plan, with a $0 copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, while acupuncture, meal benefits, 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. This plan offers Nicotine Replacement Therapy (NRT) and Naloxone coverage as a Part C OTC benefit, but does not cover all drugs on the CMS OTC list.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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