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AARP Medicare Advantage Essentials from UHC WI-13 (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 WI-13 (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 WI-13 (HMO-POS) in 2026, please refer to our full plan details page.
AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Wisconsin. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage Essentials from UHC WI-13 (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 WI-13 (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 WI-13 (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 $520.00 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 $4900.00 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:
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Drug Coverage
The AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) plan features an annual drug deductible of $520. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies, or for a 3-month supply via mail order. Tier 2 generic medications cost $12 for a 1-month standard pharmacy supply, but you can receive a 3-month supply with no copay through preferred mail order. Higher-tier prescription drugs are covered under coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 15% coinsurance, while Tier 4 non-preferred drugs have a 39% coinsurance for a 1-month supply. Tier 5 specialty drugs carry a 27% coinsurance for a 1-month supply across standard pharmacies and mail order options.
Additional Benefits
The AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) plan offers affordable coverage with no copay and no coinsurance for primary care visits, telehealth services, and routine preventive care. For hospital care, inpatient stays require a $455 daily copay for the first six days with no copay for subsequent days, while emergency room visits carry a $130 copay that is waived upon admission. Outpatient hospital services feature no coinsurance, with copays ranging from no copay up to $455 depending on the service. Routine dental, vision, and hearing services are also covered, featuring no copay for annual eye and hearing exams, alongside a $1,000 annual limit with no copay for preventive dental care. Hearing aids are available with copays ranging from $199 to $1,249, and covered eyewear is subject to a $300 maximum limit every two years. Finally, skilled nursing facility stays require no copay for the first 20 days, and home health services are fully covered with no copay or coinsurance.
Inpatient Hospital See details
AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) partially covers inpatient hospital services with no coinsurance, excluding upgrades, psychiatric additional days, and non-Medicare-covered stays. Medicare-covered acute stays require a $455 daily copay for days 1-6 (no copay for days 7 and beyond), while psychiatric stays require a $455 daily copay for days 1-5 (no copay for days 6-90).
Outpatient Services See details
Outpatient services are covered by AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services require copays ranging from $0 to $455, while outpatient substance abuse services carry copays of $0 to $25 per session, with prior authorization required.
Partial Hospitalization See details
AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) plan, which features a $275 copay and no coinsurance for both ground and air ambulance services, subject to prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) 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 $0 to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Primary care benefits under the AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) include primary care and telehealth visits with no copay and no coinsurance. Specialist visits range from a $0 to $45 copay, therapy services have a $25 copay, and mental health services range from a $0 to $25 copay, all with no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) with no copay and no coinsurance for covered options such as annual physical exams, fitness benefits, kidney disease education, and diabetes self-management. However, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, extra smoking cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS), including one annual routine hearing exam with no copay and no coinsurance, though fitting and evaluation services are not covered. Prescription hearing aids have a copay of $199 to $1,249 and OTC hearing aids have a copay of $199 to $829, both with no coinsurance, but inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) partially covers vision services with no deductible and no coinsurance, offering one routine eye exam annually with no copay under prior authorization, though other eye exams are not covered. Covered eyewear options like contact lenses, frames, and lenses (with a copay of $0 to $153) are subject to a $300 maximum limit every two years, while upgrades and complete eyeglass packages are excluded.
Dental Services See details
Dental services are covered by AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS), featuring preventive care with no copay and no coinsurance up to a $1,000 annual maximum. Comprehensive dental services are partially covered with no copay and a 50% coinsurance, excluding implant services and orthodontics, while Medicare-covered dental services have no copay and a 20% coinsurance.
Home Infusion bundled Services See details
AARP Medicare Advantage Essentials from UHC WI-13 (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 copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Medical equipment is covered by AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are covered with no copay, and prior authorization is required for most of these services.
Diagnostic and Radiological Services See details
AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) covers diagnostic and radiological services with prior authorization required. Lab services have no copay or coinsurance, diagnostic tests require a $50 copay with no coinsurance, outpatient X-rays have a $30 copay, therapeutic radiology requires a 20% coinsurance, and diagnostic radiology copays start at $0.
Home Health Services See details
Home health services are covered by AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) plan. While some services are covered with no coinsurance and no copay under prior authorization, the plan does not cover standard cardiac, intensive cardiac, pulmonary, or supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS) with no coinsurance, and no prior three-day hospital stay is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and prior authorization is required.
Other Services See details
Other Services are partially covered by AARP Medicare Advantage Essentials from UHC WI-13 (HMO-POS), which features a chronic illness meal benefit with no copay and no coinsurance, though prior authorization is required. Supplemental services such as acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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