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AARP Medicare Advantage from UHC NY-0013 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NY-0013 (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-0013 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC NY-0013 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in New York. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage from UHC NY-0013 (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-0013 (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-0013 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.00. 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 $13900.00 (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 $13900.00 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-0013 (PPO) plan features an annual drug deductible of $600. Under this plan, Tier 1 preferred generic drugs have no copay for a 1-month or 3-month supply at standard pharmacies and through mail order. Tier 2 generic drugs require a $14 copay for a 1-month standard pharmacy supply, but you can get a 3-month supply with no copay through preferred mail order. For Tier 3 preferred brand drugs, you will pay a 16% coinsurance for standard pharmacy and mail order prescriptions. Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 34% coinsurance and a 26% coinsurance respectively for a 1-month supply. This structure helps you estimate your out-of-pocket prescription medication expenses with this Medicare Advantage plan.
Additional Benefits
The AARP Medicare Advantage from UHC NY-0013 (PPO) plan offers comprehensive coverage with many essential services requiring no copay and no coinsurance, including primary care visits, routine eye exams, and preventive dental care. For inpatient hospital stays, members pay a $450 daily copay for the first five days, followed by no copay for the remaining days of their stay. Emergency room visits carry a $115 copay, which is waived if admitted, while specialist office visits feature a low copay ranging from no copay to $55. Routine hearing exams are covered with no copay, while prescription hearing aids require copayments ranging from $199 to $1,249. Diagnostic lab services and home health care also feature no copay, whereas durable medical equipment and dialysis services require a 20% coinsurance. Additionally, skilled nursing facility care is covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
AARP Medicare Advantage from UHC NY-0013 (PPO) covers inpatient acute hospital stays with no coinsurance and a $450 daily copay for days 1-5, followed by no copay for remaining and unlimited additional days. Inpatient psychiatric stays are covered with no coinsurance and a $450 daily copay for days 1-4, then no copay for days 5-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by AARP Medicare Advantage from UHC NY-0013 (PPO) with no coinsurance, featuring copays ranging from $0 to $450 for outpatient hospital services and a $450 daily copay for observation services. Ambulatory surgical center and outpatient blood services are provided with no copay and no coinsurance, while outpatient substance abuse services have no coinsurance and copays ranging from $0 to $25 for individual sessions and a flat $15 copay for group sessions.
Partial Hospitalization See details
Partial hospitalization is covered by AARP Medicare Advantage from UHC NY-0013 (PPO) with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by AARP Medicare Advantage from UHC NY-0013 (PPO), featuring a $275 copay and no coinsurance for ground and air ambulance services, while transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
AARP Medicare Advantage from UHC NY-0013 (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services feature a copay ranging from $0 to $40 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 NY-0013 (PPO) covers primary care and telehealth services with no copay and no coinsurance. Specialist visits have a $0 to $55 copay, physical and occupational therapy have a $35 to $55 copay, and chiropractic care is partially covered with a $15 copay (routine and other chiropractic services are not covered), all with no coinsurance.
Preventive Services See details
Preventive Services are partially covered by AARP Medicare Advantage from UHC NY-0013 (PPO) with no copay and no coinsurance for covered services, including annual physicals, fitness benefits, and select screenings. However, several sub-services are not covered, such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and home-based support services.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC NY-0013 (PPO), which offers one routine hearing exam per year with no copay and no coinsurance, but does not cover hearing aid fitting or evaluation. Prescription hearing aids are covered up to two per year with a $199 to $1,249 copay and no coinsurance, and OTC hearing aids are covered up to two per year with a $199 to $829 copay and 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 NY-0013 (PPO) offers partially covered vision services with no deductible and no coinsurance, featuring no copay for routine eye exams, contact lenses, and eyeglass frames, and a $0 to $153 copay for eyeglass lenses. A combined $300 maximum benefit applies to eyewear every two years, though upgrades, other eye exams, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage from UHC NY-0013 (PPO) provides partially covered dental benefits, including Medicare-covered dental services with no copay and a 20% coinsurance, and preventive care with no copay and no coinsurance. However, restorative, endodontic, periodontic, prosthodontic, orthodontic, oral surgery, implant, maxillofacial prosthetic, and adjunctive general services are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC NY-0013 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs—including chemotherapy, radiation, and insulin—require between no coinsurance and 20% coinsurance, with insulin also having a $35 copay.
Dialysis Services See details
AARP Medicare Advantage from UHC NY-0013 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
AARP Medicare Advantage from UHC NY-0013 (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. 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
AARP Medicare Advantage from UHC NY-0013 (PPO) covers diagnostic and radiological services with no coinsurance for diagnostic services, no copay for lab services and diagnostic radiology, and a $50 copay for diagnostic tests. Outpatient X-rays require a $30 copay, while therapeutic radiological services carry a 20% coinsurance, with prior authorization required for services.
Home Health Services See details
AARP Medicare Advantage from UHC NY-0013 (PPO) covers home health services 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 NY-0013 (PPO) with no copay and no coinsurance, subject to prior authorization. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AARP Medicare Advantage from UHC NY-0013 (PPO) with no coinsurance and do not require a prior three-day hospital stay. There is no copay for days 1 through 20, while days 21 through 100 require a $218 daily copay, with prior authorization required and no coverage for additional days.
Other Services See details
AARP Medicare Advantage from UHC NY-0013 (PPO) partially covers other services, offering a meal benefit for chronic illnesses with no copay and no coinsurance, subject to prior authorization. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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