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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 2025, 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 out of 5 stars in 2025.
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 $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 $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-0013 (PPO) plan has a $570 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $14 copay for preferred generic drugs at a standard pharmacy. For preferred brand drugs, you will pay a $100 copay. For non-preferred drugs, you will pay 26% coinsurance. Once your total yearly 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-0013 (PPO) plan offers a variety of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $275. Emergency and primary care services have copays, and the plan also covers preventive, hearing, vision, dental, and home health services, often with no copay. The plan also includes coverage for ambulance, partial hospitalization, and home infusion services, with copays and coinsurance applicable to certain services. Diagnostic, radiological, and medical equipment services are covered, but may include coinsurance or copays. Other benefits such as cardiac rehabilitation and skilled nursing facility services are covered with prior authorization and copays.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-4, and no copay for days 5-90, while additional days 91-999 have no copay; Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital Psychiatric, you will pay a $275 copay for days 1-4, and no copay for days 5-90; additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $275, and observation services with a $275 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a copay between $0 and $25 for individual sessions, and a $15 copay for group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this 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 from UHC NY-0013 (PPO) plan. Ground and Air Ambulance Services have a copay of $275, but there is no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under this plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.
Primary Care See details
The AARP Medicare Advantage from UHC NY-0013 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy with a copay between $0 and $35. Physician specialist services have a copay from $0 to $55, while mental health and psychiatric services have varying copays depending on the session type. The plan also covers podiatry services and other health care professional visits with varying copays, physical therapy and speech-language pathology services with a copay between $0 and $50, and additional telehealth benefits with no copay. Opioid treatment program services are covered with no copay.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Other preventive services such as Health Education, In-Home Safety Assessment, and several others are not covered, but Fitness Benefit is covered with no copay.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and over-the-counter (OTC) hearing aids. Routine hearing exams have no copay, while prescription hearing aids have a copay between $199 and $1249. OTC hearing aids have a copay between $99 and $829. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear has a combined maximum benefit of $200 every two years, and includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
AARP Medicare Advantage from UHC NY-0013 (PPO) covers dental services, including a 20% coinsurance for Medicare Dental Services. Other services include Oral Exams, Dental X-Rays, Other Diagnostic, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive, Restorative, Adjunctive General, Endodontics, Periodontics, Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery, all with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage from UHC NY-0013 (PPO) plan and require prior authorization. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a 20% coinsurance, and durable medical equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance. Diabetic supplies have no copay, while diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a $50 copay, and lab services with no copay. Diagnostic Radiological Services have a maximum copay of $250, while Therapeutic Radiological Services have a minimum coinsurance of 20%, 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-0013 (PPO) plan 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 covered, but not the specific services Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required, and there is a copay for covered services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the AARP Medicare Advantage from UHC NY-0013 (PPO) plan, but require prior authorization. There is no 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 for AARP Medicare Advantage from UHC NY-0013 (PPO) includes a Meal Benefit with no copay, but Acupuncture, Over-the-Counter Items, 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.
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