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AARP Medicare Advantage from UHC WI-0016 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC WI-0016 (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 from UHC WI-0016 (HMO-POS) in 2025, please refer to our full plan details page.
AARP Medicare Advantage from UHC WI-0016 (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 2025.
It's important to know that AARP Medicare Advantage from UHC WI-0016 (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 from UHC WI-0016 (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 from UHC WI-0016 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.00. 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 $340.00 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 $5400.00 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 from UHC WI-0016 (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $340.00. In the initial coverage phase, after the deductible, you will pay a copay for your prescriptions. For standard generic drugs, the copay is $10.00, and for standard brand drugs, the copay is $100.00. If you reach the out-of-pocket maximum, you will pay nothing for your prescriptions.
Additional Benefits
The AARP Medicare Advantage from UHC WI-0016 (HMO-POS) plan offers a range of benefits with varying costs. Hospital stays have a copay, while many outpatient and preventive services have no copay. The plan also covers hearing, vision, and dental services, with varying copays and coinsurance. This plan includes coverage for ambulance services, emergency care, and mental health services, all with copays. Additional benefits include coverage for home health services and skilled nursing facilities, with no or low copays. However, some services such as transportation, and non-Medicare-covered stays are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $295 copay for days 1-5, and no copay for days 6-90, and additional days for Inpatient Hospital-Acute have no copay for days 91-999. Inpatient Hospital Psychiatric has a $295 copay for days 1-5, and no copay for days 6-90. However, 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 include coverage for Outpatient Hospital Services with a copay of $0-$295, Observation Services with a $295 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual Sessions for Outpatient Substance Abuse with a copay between $0-$15, Group Sessions for Outpatient Substance Abuse with a $10 copay, and Outpatient Blood Services with no copay. Prior authorization is required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the AARP Medicare Advantage from UHC WI-0016 (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, with prior authorization required for all ambulance services. Both Ground and Air Ambulance Services have a $275 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. Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0 and $55. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have no copay.
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 have a copay between $0 and $25, and no coinsurance. Physician Specialist Services have a copay between $0 and $40. Mental Health Specialty Services have a copay between $0 and $15 for individual sessions and a $10 copay for group sessions. Podiatry Services have a $40 copay for Medicare-covered services and routine foot care. Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a copay of $0-$40, $0-$15, and $0, respectively. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $25. Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional services with copays that vary based on the service. Some additional services like Health Education, In-Home Safety Assessment, and others are not covered. 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.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and over-the-counter (OTC) hearing aids. Hearing exams have no copay, routine hearing exams are limited to one per year, and fitting/evaluation for hearing aids are not covered. Prescription hearing aids have a copay between $199 and $1249 for all types of prescription hearing aids, and inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids have a copay between $99 and $829, with a limit of two hearing aids every year.
Vision Services See details
Vision services include routine eye exams with no copay, and eyewear benefits. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay, and a combined maximum of $300 every two years. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services, with a 20% coinsurance, and other dental services, with a maximum benefit of $1,000 per year. The plan covers oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery with a $0 copay, and a coinsurance that varies from 0% to 50%. Implants and orthodontics 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, there is a $35 copay and a coinsurance between 0% and 20%, while for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the AARP Medicare Advantage from UHC WI-0016 (HMO-POS) plan and require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered under the AARP Medicare Advantage from UHC WI-0016 (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance with authorization required, while Durable Medical Equipment for use outside the home is not covered. 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, including Diagnostic Procedures/Tests with a $50 copay, Lab Services with no copay, and Outpatient X-Ray Services with a $25 copay. Diagnostic Radiological Services have a maximum copay of $190, and Therapeutic Radiological Services have a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage from UHC WI-0016 (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 covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and the copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF are not covered. Non-Medicare-covered stays for SNF are also not covered.
Other Services See details
Under "Other Services", AARP Medicare Advantage from UHC WI-0016 (HMO-POS) covers Over-the-Counter (OTC) Items with no copay, and a Meal Benefit with no copay and requires 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.
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