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AARP Medicare Advantage from UHC NY-0012 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NY-0012 (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 NY-0012 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage from UHC NY-0012 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Kings, New York, and Queens Counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that AARP Medicare Advantage from UHC NY-0012 (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 NY-0012 (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 NY-0012 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan has a $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $570.00 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 $14000.00 (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 $14000.00 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 NY-0012 (PPO) plan has a $570 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, a standard pharmacy visit for a preferred generic drug has a $14 copay, while a preferred brand drug has a $100 copay. For non-preferred drugs, you pay 26% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The AARP Medicare Advantage from UHC NY-0012 (PPO) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and emergency services with a copay. The plan also covers primary care, preventive, hearing, vision, and dental services, with some services having no copay. Additional benefits include ambulance services with a copay, home health services with no copay, and skilled nursing facility care with a copay. The plan also covers other services such as acupuncture, over-the-counter items, and a meal benefit, as well as diagnostic and radiological services and medical equipment, and some prescription drugs, with various copays and coinsurance amounts.
Inpatient Hospital See details
The AARP Medicare Advantage from UHC NY-0012 (PPO) plan covers inpatient hospital stays with a $400 copay for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered. Inpatient hospital psychiatric stays have a $400 copay for days 1-4, and no copay for days 5-90, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, with a copay of $0-$400, and observation services with a $400 copay. Ambulatory Surgical Center (ASC) Services are covered with no copay, and outpatient substance abuse services are covered with a copay between $0-$25 for individual sessions and a $15 copay for group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the AARP Medicare Advantage from UHC NY-0012 (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, with prior authorization required for all ambulance services. Ground and air ambulance services have a copay of $275, but there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, including emergency services, urgently needed services, and worldwide emergency services. Emergency services have a $110 copay with no coinsurance, urgently needed services have a copay of $0-$45 with no coinsurance, and worldwide emergency services have varying copays depending on the specific service.
Primary Care See details
The AARP Medicare Advantage from UHC NY-0012 (PPO) plan covers primary care physician services with a copay between $0 and $40, chiropractic services with a $15 copay, and occupational therapy services with a copay between $0 and $20. The plan also covers physician specialist services with a copay between $0 and $55, mental health specialty services with a copay between $0 and $25 for individual sessions and $15 for group sessions, and podiatry services with a $25 copay. Other covered services include other health care professional services with a copay between $0 and $55, 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 $35, additional telehealth benefits with no copay, and opioid treatment program services with no copay.
Preventive Services See details
Preventive Services include Medicare-covered preventive services with no copay, an annual physical exam with no copay, and additional preventive services with a copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. However, services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are covered once per year with no copay; fitting/evaluation for hearing aids are not covered. Prescription hearing aids are covered, with a copay between $199 and $1249 for all types, and OTC hearing aids are covered with a copay between $99 and $829.
Vision Services See details
The AARP Medicare Advantage from UHC NY-0012 (PPO) plan covers vision services, including routine eye exams and eyewear. Routine eye exams and contact lenses have no copay, and a combined maximum of $200 is offered every two years for eyewear. Eyeglass lenses have a copay of $0-$153. Eyeglass frames have no copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The AARP Medicare Advantage from UHC NY-0012 (PPO) plan covers dental services with a 20% coinsurance for Medicare dental services, and no copay for oral exams (2 per year), dental x-rays (1 every 3 years), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), and other preventive dental services (1 per year). Orthodontic, restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is 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 under the AARP Medicare Advantage from UHC NY-0012 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic procedures/tests have a $50 copay, while lab services have no copay. Diagnostic radiological services have a maximum copay of $250, and therapeutic radiological services have a 20% coinsurance, and outpatient X-ray services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage from UHC NY-0012 (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 any of the sub-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 NY-0012 (PPO) plan. You will pay no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has no copay and the plan covers up to 12 treatments per year. OTC items also have no copay, and the plan provides nicotine replacement therapy and Naloxone coverage. The meal benefit has no copay and is for a chronic illness, but requires prior authorization. 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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