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AARP Medicare Advantage CareFlex from UHC WI-18 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage CareFlex from UHC WI-18 (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 CareFlex from UHC WI-18 (HMO-POS) in 2025, please refer to our full plan details page.
AARP Medicare Advantage CareFlex from UHC WI-18 (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 CareFlex from UHC WI-18 (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 CareFlex from UHC WI-18 (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 CareFlex from UHC WI-18 (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 $495.00 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:
Sign up for AARP Medicare Advantage CareFlex from UHC WI-18 (HMO-POS)
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Drug Coverage
The AARP Medicare Advantage CareFlex from UHC WI-18 (HMO-POS) plan has a $495 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For drugs in the standard pharmacy, you will pay a $12 copay for preferred generics, $47 for standard generics, and $100 for preferred brands. Non-preferred drugs have a 27% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The AARP Medicare Advantage CareFlex plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a copay, while outpatient services often have no copay. The plan also includes coverage for ambulance, emergency, primary care, preventive, hearing, vision, dental, and home health services, with some services having no copay. Medical equipment, diagnostic services, and skilled nursing facilities are also covered, but may have coinsurance or copays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $495 copay for days 1-5, and no copay for days 6-90, and no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $495 copay for days 1-4, and no copay for days 5-90, and no coinsurance. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, outpatient substance abuse services, outpatient blood services, and ambulatory surgical center services. Outpatient Hospital Services have a copay of $0-$495, Observation Services have a copay of $495, Individual Sessions for Outpatient Substance Abuse have a copay of $0-$55, Group Sessions for Outpatient Substance Abuse have a copay of $55, Outpatient Blood Services have no copay, and Ambulatory Surgical Center (ASC) Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $105 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AARP Medicare Advantage CareFlex from UHC WI-18 (HMO-POS) plan. 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, including urgently needed and worldwide emergency services, are covered by the AARP Medicare Advantage CareFlex from UHC WI-18 (HMO-POS) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $55. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The AARP Medicare Advantage CareFlex from UHC WI-18 (HMO-POS) plan covers primary care services with no copay, chiropractic services with a $20 copay, occupational therapy services with a copay between $0 and $45, and specialist services with a copay between $0 and $50. Mental health services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are also covered.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered, and some services require a copay, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $50 copay, while routine hearing exams have no copay for one exam per year. Prescription hearing aids are covered with a copay between $199 and $1249 for two hearing aids per year, but hearing aid fitting/evaluation, and prescription hearing aids for inner ear, outer ear, and over the ear are not covered. OTC hearing aids are covered with a copay between $99 and $829 for two hearing aids per year.
Vision Services See details
Vision services include routine eye exams with no copay, and eyewear benefits that include contact lenses, eyeglass lenses, and eyeglass frames. Eyeglass lenses have a copay of $0-$153, while contact lenses, and eyeglass frames have no copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, and other preventive dental services. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatments, and other preventive dental services have no copay, while Medicare Dental Services have a 20% coinsurance. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, and Oral and Maxillofacial Surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. For Medicare Part B insulin drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the AARP Medicare Advantage CareFlex from UHC WI-18 (HMO-POS) plan. This plan requires prior authorization and has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment benefits are covered, including Durable Medical Equipment (DME) with a 50% coinsurance and Prosthetics/Medical Supplies with a 50% coinsurance. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 50% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay of $45, lab services with no copay, and diagnostic radiological services with a copay of up to $250. Outpatient X-ray services have a $50 copay, and therapeutic radiological services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage CareFlex from UHC WI-18 (HMO-POS) plan with no copay and no coinsurance. 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 by AARP Medicare Advantage CareFlex from UHC WI-18 (HMO-POS), but require prior authorization. There is no copay for days 1-20, but there is a $203 copay for days 21-100.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits. Over-the-Counter (OTC) Items have no copay, while Meal Benefits also have no copay and require prior authorization.
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