AARP Medicare Advantage Essentials from UHC UT-4 (HMO-POS)

Inpatient Hospital See details

Inpatient Hospital benefits are covered, with a copay of $345 for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute have no copay for days 91-999, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient services including hospital services, observation services, substance abuse services, and blood services are covered. Outpatient Hospital Services have a copay between $0 and $345, Observation Services have a $345 copay, Individual Sessions for Outpatient Substance Abuse have a copay between $0 and $25, Group Sessions for Outpatient Substance Abuse have a $15 copay, and Outpatient Blood Services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered by the AARP Medicare Advantage Essentials from UHC UT-4 (HMO-POS) plan, with a $55 copay. Prior authorization is required for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the AARP Medicare Advantage Essentials from UHC UT-4 (HMO-POS) plan. Ground and Air Ambulance Services have a $260 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the AARP Medicare Advantage Essentials from UHC UT-4 (HMO-POS) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0 and $55, but both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.

Primary Care See details

Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay, but routine care is not covered.

Occupational Therapy Services are covered with a copay between $0 and $20. Physician Specialist Services, Mental Health Specialty Services, and Psychiatric Services are covered with a copay between $0 and $30.

Podiatry Services have a $30 copay for Medicare-covered services and routine foot care, limited to 6 visits per year. Other Health Care Professional Services have a copay between $0 and $30.

Physical Therapy and Speech-Language Pathology Services are covered with a copay between $0 and $20. Additional Telehealth Benefits are covered with no copay.

Opioid Treatment Program Services have no copay.

Preventive Services See details

Preventive services include no copay for annual physical exams. Additional preventive services, including Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay. Some services, such as Health Education, are not covered.

Hearing Services See details

Hearing exams are covered with no copay, and routine hearing exams are limited to one per year. Prescription hearing aids are covered with a copay between $199 and $1249, with a limit of two per year, 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, including routine eye exams. Eyewear has no copay for contact lenses and eyeglass frames, but the plan does not cover eyeglasses (lenses and frames) or upgrades.

Dental Services See details

Dental services include a 20% coinsurance for Medicare dental services, with prior authorization required. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay. Other services like orthodontics, restorative services, and others are not covered.

Home Infusion bundled Services See details

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

Dialysis Services See details

Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under this plan. Durable Medical Equipment has a 20% coinsurance and requires authorization, while prosthetic devices 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 include coverage for Diagnostic Procedures/Tests with a $25 copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $160, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $25 copay.

Home Health Services See details

Home Health Services are covered by the AARP Medicare Advantage Essentials from UHC UT-4 (HMO-POS) plan with no copay and no coinsurance; however, Additional Hours of Care and Personal Care Services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the AARP Medicare Advantage Essentials from UHC UT-4 (HMO-POS) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the AARP Medicare Advantage Essentials from UHC UT-4 (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.

Other Services See details

The AARP Medicare Advantage Essentials from UHC UT-4 (HMO-POS) plan offers Over-the-Counter (OTC) items with no copay, and a meal benefit with no copay, but both require prior authorization. Other services such as 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.