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AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) in 2026, please refer to our full plan details page.
AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Washington. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) 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 Essentials from UHC WA-7 (HMO-POS).
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 Essentials from UHC WA-7 (HMO-POS), 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $355.00 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 Maximum Out-Of-Pocket cost of $5900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Essentials from UHC WA-7 (HMO-POS) prescription drug plan features an annual drug deductible of $355. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay for one-month or three-month fills at standard pharmacies, nor for three-month standard mail orders. This plan offers cost-effective options for common medications to help keep your healthcare expenses low. For higher-tier medications, costs are based on coinsurance during the initial coverage phase. Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs have a 43% coinsurance. Tier 5 specialty drugs are covered with a 29% coinsurance for a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) plan offers robust healthcare coverage with no copay for primary care, telehealth, and preventive services. For inpatient hospital stays, members pay a $450 daily copay for days 1 through 5 and no copay for days 6 through 90, with no coinsurance required. Outpatient hospital care, specialist visits, and emergency services are also covered with low to no copays and no coinsurance. Additional benefits include routine dental, vision, and hearing exams with no copays, plus up to a $300 allowance for vision hardware every two years. Home health care features no copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Skilled nursing facility care is covered with no copay for the first 20 days, followed by a $218 daily copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) with no coinsurance, though prior authorization is required. For both acute and psychiatric stays, you will pay a $450 daily copay for days 1 to 5 and no copay for days 6 to 90, while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) covers outpatient services with no coinsurance, though prior authorization is required for most services. Outpatient hospital services carry a copay of $0 to $450, outpatient substance abuse services have a copay of $0 to $25, and there is no copay for ambulatory surgical center or blood services.
Partial Hospitalization See details
AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) covers partial hospitalization with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) covers ground and air ambulance services with a $290 copay and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay of $0 to $50 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 Essentials from UHC WA-7 (HMO-POS) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance. Specialist visits, physical, occupational, and speech therapies, and podiatry require copays ranging from $0 to $40 and no coinsurance, while chiropractic services are not covered in practice because routine and other chiropractic care are excluded.
Preventive Services See details
Preventive services are covered by AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive benefits are partially covered, providing fitness benefits and home safety devices with no copays, while other sub-services like health education, nutritional therapy, and in-home support are not covered.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) with no deductibles and no coinsurance, featuring no copay for one annual routine hearing exam. While fitting and evaluation exams, alongside inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered, other prescription and OTC hearing aids are covered up to two per year with copays ranging from $199.00 to $1,249.00.
Vision Services See details
AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) offers partially covered vision services with no coinsurance and no copays for routine eye exams, contact lenses, and frames, up to a $300 maximum every two years. Eyeglass lenses have a copay of $0 to $153, while other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS), offering Medicare-covered dental with no copay and 20% coinsurance, and preventive care with no copay and no coinsurance. However, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance, while covered Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) plan with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required. There is no copay for these benefits, but a 20% coinsurance applies to DME, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) with no coinsurance, though prior authorization is required. Members pay no copay for lab services and diagnostic radiological services, a $25 copay for diagnostic procedures and tests, a $30 copay for outpatient X-rays, and an $80 copay for therapeutic radiological services.
Home Health Services See details
AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) 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 offered by AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the AARP Medicare Advantage Essentials from UHC WA-7 (HMO-POS), offering over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered, and the meal benefit requires prior authorization.
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