AARP Medicare Advantage from UHC TX-0013 (HMO-POS)

Inpatient Hospital See details

Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 5 days of an inpatient stay, the copay is $175 per day; for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $175, observation services with a $175 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, while outpatient blood services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered with no copay. Prior authorization and a doctor referral are required.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by AARP Medicare Advantage from UHC TX-0013 (HMO-POS), including ground and air ambulance services with a $275 copay, and transportation services with no copay. Transportation services to any health-related location are not covered. Plan-approved health-related transportation is covered for up to 12 one-way trips per year.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $140 copay, and Urgently Needed Services has a copay between $0 and $65; all services have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.

Primary Care See details

Primary Care services include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay (routine care not covered), Occupational Therapy Services with a copay between $0 and $20, Physician Specialist Services with a copay between $0 and $20, Mental Health Specialty Services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, Other Health Care Professional services with a copay between $0 and $20, Psychiatric Services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, Physical Therapy and Speech-Language Pathology Services with a copay between $0 and $20, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay. Prior authorization and a doctor referral are required for Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services.

Preventive Services See details

Preventive services include an annual physical exam with no copay, while additional preventive services and kidney disease education services may have a copay. This plan also covers glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered. Home and bathroom safety devices and modifications, as well as fitness benefits, are covered with no copay.

Hearing Services See details

Hearing exams are covered with no copay, and routine hearing exams are covered once per year with no copay. Prescription hearing aids are 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 aids, 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 and eyewear. Eye exams have no copay, and eyewear has no copay for contact lenses and eyeglass frames, and a copay of $0 - $153 for eyeglass lenses, and a combined maximum plan benefit of $300 for all eyewear every two years.

Dental Services See details

Dental Services are covered, with 20% coinsurance for Medicare Dental Services. Other Dental Services are covered, with a maximum plan benefit of $2,500 per year.

Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and oral and maxillofacial surgery all have no copay.

Restorative Services, Prosthodontics, fixed, and Prosthodontics, removable have a copay of $0 and coinsurance between 0% and 50%.

Maxillofacial Prosthetics, Adjunctive General Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery all have no copay.

Implant Services and Orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered under the AARP Medicare Advantage from UHC TX-0013 (HMO-POS) plan. This plan requires prior authorization and a doctor referral, with a coinsurance of 20%.

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 requires authorization. Prosthetic Devices have a 20% coinsurance and Medical Supplies have a 20% coinsurance. 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, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests have a $50 copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250, Therapeutic Radiological Services have at most 20% coinsurance, and Outpatient X-Ray Services have a $15 copay.

Home Health Services See details

Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A doctor referral and prior authorization are required for Cardiac Rehabilitation Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered under the AARP Medicare Advantage from UHC TX-0013 (HMO-POS) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered, and non-Medicare-covered stays, are not covered.

Other Services See details

The AARP Medicare Advantage from UHC TX-0013 (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, and Meal Benefits with no copay and 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.