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AARP Medicare Advantage Essentials from UHC TX-11 (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 TX-11 (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 TX-11 (HMO-POS) in 2026, please refer to our full plan details page.
AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Texas. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage Essentials from UHC TX-11 (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 TX-11 (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 TX-11 (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 $3700.00 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:
Sign up for AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS)
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Drug Coverage
The AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) plan features an annual drug deductible of $355. For Tier 1 preferred generic and Tier 2 generic medications, members enjoy no copay for 1-month and 3-month supplies at standard pharmacies, as well as no copay for 3-month standard mail orders. This coverage helps lower out-of-pocket costs for common prescriptions. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require an 18% coinsurance for standard pharmacy and standard mail-order fills. Tier 4 non-preferred drugs carry a 42% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive services, and routine home health care. For hospital stays, members pay a $95 daily copay for days 1 through 6 of inpatient care, while emergency room visits carry a $150 copay that is waived upon hospital admission. Specialist visits and therapy services are also highly affordable, requiring copays ranging from no copay to $25 with no coinsurance. Additional benefits include routine vision and hearing exams with no copay, alongside a $1,500 annual allowance for preventive dental care with no copay or coinsurance. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance, while members also benefit from covered over-the-counter items and up to 24 one-way transportation trips per year with no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) with no coinsurance, requiring a $95 copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization and referrals are required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay of $0 to $95, observation services cost a $95 daily copay, and outpatient substance abuse services range from a $0 to $25 copay, with prior authorization and referrals required.
Partial Hospitalization See details
Partial hospitalization is covered by AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) are covered with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $0 to $65 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 Essentials from UHC TX-11 (HMO-POS) offers primary care visits, telehealth, and opioid treatment with no copay and no coinsurance. Therapy services, specialist visits, podiatry, and mental health care are covered with copays ranging from $0 to $25 and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) with no copay and no coinsurance, including annual physicals, kidney disease education, glaucoma screenings, and diabetes training. Additional preventive services are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, and telemonitoring.
Hearing Services See details
AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) partially covers hearing services, offering one routine hearing exam per year with no copay and no coinsurance, though fitting and evaluation exams are not covered. Up to two prescription hearing aids are covered annually with a copay of $199.00 to $1,249.00 and no coinsurance, and up to two OTC hearing aids are covered with a $199.00 to $829.00 copay and no coinsurance, but inner ear, outer ear, and over the ear prescription aids are excluded.
Vision Services See details
Vision Services are partially covered by AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS), offering one annual routine eye exam with no copay and no coinsurance. Eyewear is also partially covered with no coinsurance and a $150 limit every two years, featuring contact lenses and frames with no copay and lenses with a $0 to $153 copay, while other exams, upgrades, and combined eyeglasses are not covered.
Dental Services See details
AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) covers preventive dental services with no copay and no coinsurance up to a $1,500 annual maximum, while Medicare-covered dental requires no copay and a 20% coinsurance. Comprehensive dental services are partially covered with no copay and a 50% coinsurance, though orthodontic and implant services are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and no coinsurance to 20% coinsurance, while insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) 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 have a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) with no coinsurance and no copay for lab services, while diagnostic procedures and tests require a $50 copay. Outpatient X-rays carry a $30 copay, diagnostic radiology has no minimum copay, and therapeutic radiology requires a minimum 20% coinsurance, with prior authorization and referrals required.
Home Health Services See details
Home Health Services are covered under the AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) plan with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) plan. While the plan technically offers these services with no copay and no coinsurance, in practice, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under the AARP Medicare Advantage Essentials from UHC TX-11 (HMO-POS) are partially covered, providing over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required for the meal benefit.
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