AARP Medicare Advantage from UHC TX-46 (HMO-POS)

Inpatient Hospital See details

Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization and a doctor's referral. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $245 copay for days 1-4, and no copay for days 5-90; additional days for Inpatient Hospital-Acute have no copay.

Outpatient Services See details

Outpatient Services, including all outpatient hospital services, are covered by this plan. For outpatient hospital services, the copay ranges from $0 to $245, and for observation services the copay is $245.

Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services are covered with a copay of $0 - $25 for individual sessions and $15 for group sessions.

Partial Hospitalization See details

Partial Hospitalization is covered with no copay, but requires prior authorization and a doctor referral.

Ambulance and Transportation Services See details

Ambulance and Transportation Services includes coverage for ground and air ambulance services, each with a $225 copay, and no coinsurance; however, transportation services to any health-related location are not covered. Prior authorization is required for all ambulance services.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a copay between $0 and $40 and 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 TX-46 (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $0-$20 copay. The plan also covers physician specialist services with a $0-$25 copay, and mental health specialty, psychiatric, and other health care professional services with varying copays depending on the service. Physical therapy and speech-language pathology services are covered with a $0-$20 copay, while additional telehealth benefits have no copay.

Preventive Services See details

Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services that may have a copay. This plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System, 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 Benefit, 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. Fitness benefits, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. Home and Bathroom Safety Devices and Modifications 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. 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, while eyewear has a combined maximum plan benefit of $250 every two years.

Dental Services See details

Dental Services are covered, with specific services like oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services having no copay. Medicare Dental Services have a 20% coinsurance, while Prosthodontics and fixed prosthodontics have a coinsurance that varies between 0% and 50%. Implant and orthodontic services are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered under the AARP Medicare Advantage from UHC TX-46 (HMO-POS) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and prior authorization required, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, Diabetic Supplies with no copay, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have a $45 copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $190, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $15 copay.

Home Health Services See details

Home Health Services are covered by the AARP Medicare Advantage from UHC TX-46 (HMO-POS) plan 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 the plan does not cover any of the sub-services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.

Other Services See details

The AARP Medicare Advantage from UHC TX-46 (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, and Meal Benefits with no copay, but requires prior authorization. Acupuncture, Dual Eligible SNPs, 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.