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AARP Medicare Advantage from UHC NC-0019 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NC-0019 (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 NC-0019 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC NC-0019 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in North Carolina. 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 NC-0019 (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 NC-0019 (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 NC-0019 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 $520.00 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 NC-0019 (PPO) plan features an annual drug deductible of $520. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies, as well as for a 3-month supply through mail order. Tier 2 generic drugs require a $10 copay for a 1-month supply at standard pharmacies, but you can get a 3-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs incur a 16% coinsurance for 1-month and 3-month fills at standard pharmacies and mail order. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 41% coinsurance and Tier 5 specialty drugs requiring a 27% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC NC-0019 (PPO) plan offers comprehensive medical coverage with no coinsurance for many key services, including inpatient hospital stays, outpatient procedures, and emergency care. Members benefit from no copay for primary care visits, annual physical exams, and home health services, while specialist visits and therapy sessions carry copays of up to $40. For inpatient hospital stays, there is a $455 copay for days 1 through 5 and no copay for days 6 through 90. Routine vision, hearing, and preventive dental services are covered with no copays, though comprehensive dental care requires a 50% coinsurance. Diagnostic lab tests and diabetic supplies also feature no copay, while standard durable medical equipment and dialysis services require a 20% coinsurance. Additionally, prescription hearing aids carry copays ranging from $199 to $1,249 with no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by AARP Medicare Advantage from UHC NC-0019 (PPO), featuring no coinsurance for both acute and psychiatric stays. You will pay a $455 copay for days 1-5 and no copay for days 6-90, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by AARP Medicare Advantage from UHC NC-0019 (PPO) feature no coinsurance, though prior authorization is required for most treatments. Patients pay no copay for ambulatory surgical center and outpatient blood services, while outpatient hospital services carry a copay of $0 to $455, and outpatient substance abuse sessions require a copay of $0 to $25.
Partial Hospitalization See details
Partial hospitalization is covered by AARP Medicare Advantage from UHC NC-0019 (PPO) with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC NC-0019 (PPO) covers ground and air ambulance services with a $150 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage from UHC NC-0019 (PPO) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services feature 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 NC-0019 (PPO) provides primary care physician and telehealth services with no copay and no coinsurance, while specialist visits range from a $0 to $40 copay with no coinsurance. Chiropractic services are only partially covered with a $15 copay and no coinsurance, as routine and other chiropractic services are not covered. Physical, occupational, and speech therapies, along with mental health and podiatry services, are covered with copays ranging up to $40 and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by the AARP Medicare Advantage from UHC NC-0019 (PPO) plan with no copay and no coinsurance for covered services such as annual physical exams, fitness benefits, kidney disease education, glaucoma screenings, and diabetes self-management training. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional or dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety devices, or counseling services.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC NC-0019 (PPO), offering one annual routine hearing exam with no copay and no coinsurance, while hearing aid fittings and evaluations are not covered. Prescription hearing aids have a copay of $199.00 to $1,249.00 and OTC hearing aids have a copay of $199.00 to $829.00, both with no coinsurance, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
AARP Medicare Advantage from UHC NC-0019 (PPO) provides partially covered vision services with no coinsurance, featuring no copay for annual routine eye exams, contact lenses, and eyeglass frames, alongside a $0.00 to $153.00 copay for eyeglass lenses up to a $200 limit every two years. Other eye exam services, eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
AARP Medicare Advantage from UHC NC-0019 (PPO) features partially covered dental services, offering preventive care with no copay and no coinsurance, and comprehensive care with no copay and 50% coinsurance up to a $1,250 annual maximum. Medicare-covered dental services have no copay and 20% coinsurance, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC NC-0019 (PPO) covers Home Infusion bundled Services with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs require coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by AARP Medicare Advantage from UHC NC-0019 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Medical Equipment is covered by AARP Medicare Advantage from UHC NC-0019 (PPO), offering 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 no copay and 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC NC-0019 (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members will pay a $5 copay for diagnostic procedures and outpatient X-rays, a minimum $60 copay for therapeutic radiology, and no copay for lab services and diagnostic radiology.
Home Health Services See details
Home Health Services are covered by AARP Medicare Advantage from UHC NC-0019 (PPO) 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 NC-0019 (PPO) with no copay and no coinsurance, although only some services are covered in practice. Under this plan, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease services are not covered, and prior authorization is required.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC NC-0019 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
AARP Medicare Advantage from UHC NC-0019 (PPO) partially covers other services, offering a meal benefit for chronic illnesses with no copay, no coinsurance, and no maximum coverage limit, subject to prior authorization. Acupuncture, over-the-counter (OTC) items, and other additional services under this benefit are not covered.
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