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AARP Medicare Advantage Essentials from UHC TX-12 (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-12 (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-12 (HMO-POS) in 2026, please refer to our full plan details page.
AARP Medicare Advantage Essentials from UHC TX-12 (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-12 (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-12 (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-12 (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:
Sign up for AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS)
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Drug Coverage
The AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) plan features an annual prescription drug deductible of $355. For Tier 1 preferred generic and Tier 2 generic medications, the plan offers no copay for 1-month and 3-month supplies filled at standard pharmacies or through standard mail order. This makes obtaining common generic prescriptions highly affordable for plan members. Higher-tier medications are covered under a coinsurance model for standard pharmacy and standard mail-order fills. Tier 3 preferred brands require a 20% coinsurance for both 1-month and 3-month supplies, while Tier 4 non-preferred drugs carry a 42% coinsurance and Tier 5 specialty drugs require a 29% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, telehealth services, annual physicals, and routine vision and hearing exams. For specialized care, members can expect affordable copays, such as up to $35 for specialist visits and up to $25 for mental health services. Routine preventive dental care is also covered with no copay, though Medicare-covered dental services require a 20% coinsurance. For hospital stays, the plan features a $325 daily copay for the first six days of inpatient care and no copay for subsequent days. Emergency room visits require a $130 copay, which is waived if you are admitted, while diagnostic services range from no copay for lab tests to a $60 copay for therapeutic radiology. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $325 copay per day for days 1 through 6 and no copay for days 7 through 90. Unlimited additional days for acute care are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) covers outpatient services with no coinsurance, though prior authorization and referrals are required. Outpatient hospital copays range from no copay to $325 (with a $325 daily copay for observation services), while ambulatory surgical center and blood services have no copay, and substance abuse sessions range from no copay to $25.
Partial Hospitalization See details
Partial hospitalization is covered by AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) with no copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, but trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered under the AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) plan 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 up to $50 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-12 (HMO-POS) covers primary care, telehealth, and opioid treatment services with no copay and no coinsurance. Specialist visits, therapies, and podiatry require copays up to $35 with no coinsurance, while mental health services have copays up to $25 with no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) with no copay and no coinsurance for annual physical exams, kidney disease education, fitness benefits, and select screenings. The benefit is partially covered, excluding sub-services like health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and alternative therapies.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS), offering one routine hearing exam annually with no copay, no coinsurance, and no deductible, though hearing aid fittings and evaluations are not covered. Prescription and OTC hearing aids are covered for up to two devices per year with no coinsurance and copays ranging from $199.00 to $1,249.00, but inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) provides partially covered vision services with no coinsurance, featuring no copay for routine eye exams and a $150 combined limit every two years for eyewear. Contact lenses and eyeglass frames are covered with no copay, and eyeglass lenses have a $0 to $153 copay, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by the AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) plan, featuring Medicare-covered dental care with no copay and a 20% coinsurance. Preventive and diagnostic services, such as cleanings and exams, are available with no copay and no coinsurance, while restorative, endodontic, periodontic, prosthodontic, oral surgery, and implant services are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required for these covered services.
Medical Equipment See details
Medical equipment is covered by AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS), with prior authorization required for these benefits. Durable medical equipment, prosthetics, and medical supplies feature no copay and a 20% coinsurance, while diabetic supplies have no copay and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) with no coinsurance, though prior authorization and referrals are required. Lab services and diagnostic radiological services have no copay, while outpatient X-rays require a $30 copay, diagnostic procedures and tests require a $50 copay, and therapeutic radiological services require a $60 copay.
Home Health Services See details
Home health services are covered by AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) covers Cardiac Rehabilitation Services with no copay and no coinsurance, although only some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered. Prior authorization and doctor referrals are required for these services.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and while a prior three-day hospital stay is not required, additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services under AARP Medicare Advantage Essentials from UHC TX-12 (HMO-POS) are partially covered, with acupuncture excluded from coverage. Over-the-counter (OTC) items and chronic illness meal benefits, which require prior authorization, are both covered with no copay and no coinsurance.
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