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AARP Medicare Advantage Essentials from UHC OH-5 (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 OH-5 (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 OH-5 (HMO-POS) in 2026, please refer to our full plan details page.
AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Ohio. 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 OH-5 (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 OH-5 (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 OH-5 (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 $440.00 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 Essentials from UHC OH-5 (HMO-POS) prescription drug plan features an annual drug deductible of $440. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies, or for a 3-month supply through mail order. Tier 2 generic drugs carry a $12 copay for a 1-month supply at standard pharmacies, but you can save with no copay for a 3-month supply when using preferred mail order. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copays during the initial coverage phase. Tier 3 preferred brand drugs require a 15% coinsurance at standard pharmacies and mail order services. Tier 4 non-preferred drugs carry a 43% coinsurance, while Tier 5 specialty drugs require a 28% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth services, and routine preventive care. For more intensive medical needs, inpatient hospital stays require a $375 daily copay for the first six days, while emergency room visits carry a $130 copay which is waived upon admission. Outpatient services and diagnostic lab tests are also highly accessible, with many services requiring no copay. This plan also features supplemental benefits including routine dental, vision, and hearing exams with no copay, though comprehensive dental services are not covered. Members can purchase prescription or over-the-counter hearing aids with copays starting at $199, and the plan covers contacts or eyeglass frames with no copay. Additionally, skilled nursing facility stays require no copay for the first 20 days, and durable medical equipment is covered with a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital care is partially covered by the AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) plan, requiring prior authorization with no coinsurance and a $375 daily copay for days 1 through 6, and no copay for days 7 through 90 for both acute and psychiatric stays. While unlimited additional acute days are covered at no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) with no coinsurance, featuring copays ranging from $0 to $375 for outpatient hospital services and a $375 daily copay for observation services. Ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance, while outpatient substance abuse services carry no coinsurance and copays between $0 and $25 per session.
Partial Hospitalization See details
AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are offered by AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS), featuring a $275 copay and no coinsurance for both ground and air ambulance services, which require prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) with a $130 copay—which is waived if admitted to the hospital within 24 hours—and no coinsurance, while urgently needed services have a copay of $0 to $50 and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance.
Primary Care See details
Primary Care benefits under the AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) feature no copay and no coinsurance for primary care visits, telehealth, and opioid treatment. Specialist visits have a $0 to $45 copay, therapy services require a $45 copay, and mental health sessions cost up to a $25 copay, all with no coinsurance. Routine and other chiropractic services are not covered, but routine podiatry is covered for up to six visits per year with a $45 copay and no coinsurance.
Preventive Services See details
Preventive services are covered by AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) with no copay and no coinsurance for annual physicals, kidney disease education, fitness benefits, and select screenings. Additional preventive services are partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS), featuring routine hearing exams with no copay and no coinsurance, though fitting and evaluation services are not covered. The plan covers up to two prescription hearing aids (copays of $199.00 to $1,249.00) and two OTC hearing aids (copays of $199.00 to $829.00) per year with no coinsurance, but inner, outer, and over-the-ear prescription types are not covered.
Vision Services See details
AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) provides partially covered vision services with no coinsurance, including one routine eye exam per year and contact lenses or eyeglass frames with no copay. Eyeglass lenses are covered with a copay of $0 to $153 and no coinsurance up to a $300 combined maximum every two years, while other eye exams, upgrades, and bundled eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) provides partial coverage for dental services, offering preventive care like cleanings, exams, and x-rays with no copay and no coinsurance, while Medicare-covered dental services have no copay and a 20% coinsurance. However, comprehensive services such as restorative treatment, endodontics, periodontics, prosthodontics, oral surgery, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other Part B drugs, carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) covers medical equipment, offering durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay from specified manufacturers, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization needed for most items.
Diagnostic and Radiological Services See details
AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) covers diagnostic and radiological services with no copay and no coinsurance for lab tests and diagnostic radiology. Diagnostic procedures require a $50 copay and no coinsurance, outpatient X-rays have a $22 copay, and therapeutic radiological services carry 20% coinsurance.
Home Health Services See details
AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) with no copay and no coinsurance, although prior authorization is required. However, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered in practice.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
AARP Medicare Advantage Essentials from UHC OH-5 (HMO-POS) partially covers Other Services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required for the meal benefit.
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