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AARP Medicare Advantage from UHC EP-4 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC EP-4 (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 EP-4 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC EP-4 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in New Mexico and Texas. 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 EP-4 (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 EP-4 (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 EP-4 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.00. 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 $440.00 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 $6300.00 (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 $6300.00 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 EP-4 (PPO) plan has an annual prescription drug deductible of $440. Tier 1 preferred generic drugs are highly affordable, offering no copay for standard pharmacy fills and 3-month mail order supplies. For Tier 2 generic drugs, you will pay a $14 copay for a 1-month standard pharmacy supply, or no copay for a 3-month supply through preferred mail order. Brand-name and specialty medications on this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 15% coinsurance for standard pharmacy and mail order fills. Tier 4 non-preferred drugs require a 35% coinsurance, while Tier 5 specialty tier drugs carry a 28% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC EP-4 (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth services, and annual preventive exams. Specialist visits and outpatient hospital services feature low copays and no coinsurance, keeping your healthcare costs predictable. For inpatient hospital stays, members pay a daily copay of $345 for the first six days and no copay for days seven through ninety. This plan also includes valuable dental, vision, and hearing benefits to help reduce your out-of-pocket expenses. Dental coverage features no copay for preventive services up to a $3,000 annual limit, while routine eye and hearing exams are also available with no copay. Additionally, members can access covered home health care and cardiac rehabilitation services with no copay or coinsurance.
Inpatient Hospital See details
AARP Medicare Advantage from UHC EP-4 (PPO) covers inpatient hospital services with no coinsurance, requiring a $345 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional days are covered with no copay for acute care, but additional psychiatric days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC EP-4 (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center services and no copay or deductible for outpatient blood services. Outpatient hospital services require a copay ranging from $0 to $345, while outpatient substance abuse services feature copays of up to $25 for individual sessions and $15 for group sessions.
Partial Hospitalization See details
Partial hospitalization services are covered by the AARP Medicare Advantage from UHC EP-4 (PPO) plan with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC EP-4 (PPO) covers Medicare-covered ground and air ambulance services with a $275 copay per service and no coinsurance, subject to prior authorization. Non-emergency transportation services to health-related locations are not covered by this plan.
Emergency Services See details
AARP Medicare Advantage from UHC EP-4 (PPO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services have a copay ranging from $0 to $65 and 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 EP-4 (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits range from a $0 to $45 copay with no coinsurance. Physical, occupational, and speech therapy require a $40 copay with no coinsurance, whereas chiropractic services are not covered in practice. Mental health, psychiatric, and podiatry services are covered with no coinsurance and copays ranging up to $45.
Preventive Services See details
Preventive Services are partially covered by AARP Medicare Advantage from UHC EP-4 (PPO) with no copay and no coinsurance for covered services like annual physical exams, fitness benefits, and safety devices. However, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
AARP Medicare Advantage from UHC EP-4 (PPO) provides partially covered hearing services, including one annual routine hearing exam with no copay or coinsurance, though fitting and evaluation services are not covered. Up to two prescription hearing aids (with copays from $199.00 to $1,249.00) and two OTC hearing aids (with copays from $199.00 to $829.00) are covered per year with no coinsurance, although inner ear, outer ear, and over-the-ear prescription models are excluded.
Vision Services See details
AARP Medicare Advantage from UHC EP-4 (PPO) partially covers vision services with no coinsurance, offering no copay for annual routine eye exams and eyewear benefits ranging from no copay to a $153 copay. A combined $200 eyewear limit applies every two years, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage from UHC EP-4 (PPO) offers partially covered dental services up to a $3,000 annual limit, excluding implant services and orthodontics. Covered preventive services feature no copay and no coinsurance, while Medicare-covered services require no copay with 20% coinsurance, and other comprehensive services require no copay with 50% coinsurance.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC EP-4 (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the AARP Medicare Advantage from UHC EP-4 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
AARP Medicare Advantage from UHC EP-4 (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the AARP Medicare Advantage from UHC EP-4 (PPO) plan with no coinsurance, though prior authorization is required. Lab services require no copay, while diagnostic procedures have a $20 copay, outpatient X-rays have a $30 copay, therapeutic radiology has a $60 minimum copay, and diagnostic radiology has a $0 minimum copay.
Home Health Services See details
Home Health Services are covered by AARP Medicare Advantage from UHC EP-4 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under AARP Medicare Advantage from UHC EP-4 (PPO) with no copay and no coinsurance, subject to prior authorization. However, only some services are covered, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC EP-4 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
AARP Medicare Advantage from UHC EP-4 (PPO) partially covers other services, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires prior authorization.
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