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AARP Medicare Advantage from UHC NY-0026 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NY-0026 (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-0026 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage from UHC NY-0026 (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-0026 (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-0026 (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-0026 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.00. 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-0026 (PPO) plan has an enhanced alternative drug benefit. The plan has a $570 deductible for prescription drugs. After your deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $12 copay for preferred generic drugs at a standard pharmacy, and 26% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The AARP Medicare Advantage from UHC NY-0026 (PPO) plan offers comprehensive coverage with a focus on outpatient services, including primary care, vision, and dental. Many services, such as primary care visits, preventive services, hearing exams, and dental cleanings, are available with no copay. The plan also covers inpatient hospital stays, emergency services, and various therapies with varying copays. This plan includes coverage for prescription hearing aids, eyewear, and medical equipment. It also provides coverage for home health services and offers additional benefits like over-the-counter items and meal benefits. However, some services, such as cardiac rehabilitation and additional hours of care, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $405 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you pay a $405 copay for days 1-4, and no copay for days 5-90. Additional Days for Inpatient Hospital-Acute are covered with no copay for days 91-999.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $405, observation services with a $405 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with 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 under this plan, but requires prior authorization. You will have a $55 copay 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 $290, with no coinsurance. 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 by the AARP Medicare Advantage from UHC NY-0026 (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a copay between $0 and $45; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The AARP Medicare Advantage from UHC NY-0026 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a copay between $0 and $20, and physician specialist services with a copay between $0 and $40. Additionally, mental health and psychiatric services, podiatry services, other health care professional services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered, and there is no copay for additional telehealth benefits and opioid treatment program services. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include a yearly physical exam with no copay, and other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Additional preventive services are covered, but specific copays apply to Fitness Benefit and Home and Bathroom Safety Devices and Modifications. Some services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others.
Hearing Services See details
Hearing exams are covered with no copay. Prescription hearing aids are partially covered, with a copay between $199 and $1249, and OTC hearing aids are covered with a copay between $99 and $829. Fitting/Evaluation for Hearing Aid, 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 with no copay, routine eye exams with no copay, and eyewear including contact lenses, eyeglass lenses, and eyeglass frames. Eyeglasses (lenses and frames) and upgrades are not covered. The plan offers a combined maximum of $300 for eyewear every two years.
Dental Services See details
Dental Services are covered, with 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the AARP Medicare Advantage from UHC NY-0026 (PPO) plan, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance is between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage from UHC NY-0026 (PPO) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under this plan. Diagnostic Procedures/Tests have a copay of $25, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $250, Therapeutic Radiological Services have a copay of $80, and Outpatient X-Ray Services have a copay of $25.
Home Health Services See details
Home Health Services are covered under the AARP Medicare Advantage from UHC NY-0026 (PPO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the AARP Medicare Advantage from UHC NY-0026 (PPO) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the AARP Medicare Advantage from UHC NY-0026 (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $203 copay for days 21-100, and additional days beyond Medicare-covered for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
The AARP Medicare Advantage from UHC NY-0026 (PPO) plan covers Over-the-Counter (OTC) Items and Meal Benefits. OTC items have no copay, while Meal Benefits also have no copay and require prior authorization. Acupuncture, 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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