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AARP Medicare Advantage Essentials from UHC PA-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 PA-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 PA-5 (HMO-POS) in 2026, please refer to our full plan details page.
AARP Medicare Advantage Essentials from UHC PA-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 Pennsylvania. 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 PA-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 PA-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 PA-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 $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 $6700.00 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 PA-5 (HMO-POS) prescription drug plan has an annual deductible of $520. Tier 1 preferred generic drugs are highly affordable, requiring no copay for 1-month or 3-month supplies at standard pharmacies and through mail order. Tier 2 generic drugs cost $5 for a 1-month supply at standard pharmacies, but you can get a 3-month supply with no copay through preferred mail order. For higher-tier medications, the plan transitions from flat copays to percentage-based coinsurance. Tier 3 preferred brand-name drugs require a 16% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 40% and 27% coinsurance respectively for a 1-month supply. These options allow you to balance convenience and cost savings when filling your prescriptions at standard pharmacies or via mail order.
Additional Benefits
The AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) plan offers robust medical coverage featuring no coinsurance for many key services, including inpatient hospital stays, outpatient care, and emergency visits. Members benefit from no copay for primary care physician visits, telehealth services, and routine preventive care. For specialist consultations, emergency room visits, and inpatient hospital stays, affordable copays apply with no coinsurance to keep your out-of-pocket costs predictable. Routine dental, vision, and hearing exams are also covered with no copays or coinsurance, although comprehensive dental services are not covered under this plan. Other services, such as dialysis, durable medical equipment, and certain Part B drugs, require a 20% coinsurance, while home health services are provided with no copay. Additionally, the plan includes extra perks like fitness benefits and over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care requires a $425 copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric care requires a $425 copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from $0 to $425, and outpatient substance abuse services have copays between $0 and $25, with prior authorization required for most care.
Partial Hospitalization See details
Partial hospitalization is covered by AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) covers ground and air ambulance services with a $275.00 copay and no coinsurance, though prior authorization is required. While transportation benefits are technically covered, some services are covered but transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage Essentials from UHC PA-5 (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 copays and no coinsurance.
Primary Care See details
AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) offers primary care physician visits and telehealth services with no copay and no coinsurance. Specialist visits, outpatient therapies, and podiatry require copays ranging up to $45 with no coinsurance, though routine and other chiropractic services are not covered. Mental health and psychiatric sessions are also covered with no coinsurance and copays up to $25.
Preventive Services See details
Preventive Services are partially covered by AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) with no copay and no coinsurance for covered services such as annual exams, fitness benefits, and kidney disease education. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, 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 PA-5 (HMO-POS), featuring one routine hearing exam annually with no copay, no coinsurance, and no deductible, though fitting and evaluation exams are not covered. Covered prescription hearing aids carry a copay of $199.00 to $1,249.00 with no coinsurance, and OTC hearing aids require a $199.00 to $829.00 copay with no coinsurance, but inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS), featuring no deductibles, no coinsurance, and no copay for annual routine eye exams. Eyewear is covered up to a $150 limit every two years with no copay for contacts and frames, and a $0 to $153 copay for lenses, though other eye exam services, eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) plan, which features no copay and a 20% coinsurance for Medicare-covered dental care, and no copay or coinsurance for preventive services like exams, cleanings, and x-rays. Comprehensive dental options, including restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, require no coinsurance up to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment is covered under the AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) plan with no copays, though a 20% coinsurance applies to durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS), with prior authorization required. Diagnostic tests require a $50 copay with no coinsurance, lab and diagnostic radiological services have no copays, outpatient X-rays require a $30 copay, and therapeutic radiology carries a 20% coinsurance.
Home Health Services See details
Home health services are covered under the AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered with no copay and no coinsurance under the AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) plan, though prior authorization is required. In practice, some services are covered, but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $218 copay per day for days 21 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS), which provides over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance. Prior authorization is required for the meal benefit, while acupuncture and other additional services are not covered.
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