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AARP Medicare Advantage from UHC NY-0019 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NY-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 NY-0019 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC NY-0019 (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-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 NY-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 NY-0019 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.00. 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-0019 (PPO) plan features an annual drug deductible of $600. For Tier 1 preferred generic drugs, members pay no copay for 1-month or 3-month fills at standard pharmacies, or for 3-month mail-order prescriptions. Tier 2 generic medications carry a $12 copay for a 1-month supply at standard pharmacies, though a 3-month supply is available with no copay through preferred mail order. For higher-tier medications, costs are based on coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 16% coinsurance for both standard pharmacy and mail-order options. Tier 4 non-preferred drugs carry a 41% coinsurance, while Tier 5 specialty tier medications require a 26% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC NY-0019 (PPO) plan offers robust coverage for essential medical services, featuring no copays for primary care visits, annual physicals, and preventive screenings. Emergency care is available with a $115 copay, which is waived upon hospital admission, while inpatient hospital stays require a $550 daily copay for the first few days and no copay thereafter. Specialist visits range from no copay to a $55 copay, and outpatient surgical services are fully covered with no copay or coinsurance. Routine vision and hearing exams are highly accessible with no copays, alongside allowances for eyewear and hearing aids to help manage out-of-pocket costs. Skilled nursing facility care starts with no copay for the first 20 days, and preventive dental cleanings are covered at no cost, though more complex dental and cardiac rehabilitation services are not covered. For specialized care, home health services feature no copay, while dialysis and durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
AARP Medicare Advantage from UHC NY-0019 (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $550 daily copay for days 1-4 and no copay for days 5 and beyond, while psychiatric stays require a $550 daily copay for days 1-3 and no copay for days 4-90; non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by AARP Medicare Advantage from UHC NY-0019 (PPO) with no coinsurance, though prior authorization is required. Covered ambulatory surgical center and outpatient blood services have no copay, while outpatient hospital services require a copay of $0 to $550, and outpatient substance abuse sessions have copays ranging from $0 to $25.
Partial Hospitalization See details
AARP Medicare Advantage from UHC NY-0019 (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC NY-0019 (PPO) covers ground and air ambulance services with a $290 copay and no coinsurance, though prior authorization is required and the copay is not waived upon hospital admission. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
AARP Medicare Advantage from UHC NY-0019 (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed care is covered with a $0 to $40 copay 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 NY-0019 (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits range from a $0 to $55 copay with no coinsurance. Other services like physical therapy ($40 copay), occupational therapy ($25 copay), and podiatry ($45 copay) also feature no coinsurance, though chiropractic services are not covered.
Preventive Services See details
AARP Medicare Advantage from UHC NY-0019 (PPO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. While a fitness benefit is also covered with no copay and no coinsurance, other supplemental benefits such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
AARP Medicare Advantage from UHC NY-0019 (PPO) offers partially covered hearing services, including one routine hearing exam annually with no copay and no coinsurance, though fitting and evaluation services are not covered. Up to two prescription hearing aids (excluding inner ear, outer ear, and over-the-ear types) and two over-the-counter hearing aids are covered per year with no coinsurance, carrying copays of $199 to $1,249 and $199 to $829, respectively.
Vision Services See details
Vision services are partially covered by AARP Medicare Advantage from UHC NY-0019 (PPO), offering one annual routine eye exam with no copay and no coinsurance. Covered eyewear has no coinsurance and a $200 limit every two years, with no copay for contact lenses or frames and a $0 to $153 copay for lenses, while other eye exam services, upgrades, and combined eyeglasses are not covered.
Dental Services See details
AARP Medicare Advantage from UHC NY-0019 (PPO) provides partially covered dental services, offering preventive care such as cleanings and exams with no copay and no coinsurance, while Medicare-covered dental services require no copay and a 20% coinsurance. However, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, adjunctive general services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by AARP Medicare Advantage from UHC NY-0019 (PPO) with no copay and no coinsurance, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs feature no copay and 0% (no coinsurance) to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% (no coinsurance) to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under AARP Medicare Advantage from UHC NY-0019 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to access these covered services.
Medical Equipment See details
AARP Medicare Advantage from UHC NY-0019 (PPO) covers 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-0019 (PPO) covers diagnostic and radiological services with no coinsurance for diagnostic services, offering no copay for lab services and diagnostic radiology. Members will pay a $40 copay for diagnostic procedures and tests, a $30 copay for outpatient X-rays, and a 20% coinsurance for therapeutic radiological services, with prior authorization required.
Home Health Services See details
AARP Medicare Advantage from UHC NY-0019 (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the AARP Medicare Advantage from UHC NY-0019 (PPO) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by AARP Medicare Advantage from UHC NY-0019 (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by AARP Medicare Advantage from UHC NY-0019 (PPO), featuring a meal benefit for chronic illness 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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