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UHC MedicareMax Medicare Advantage FL-0028 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC MedicareMax Medicare Advantage FL-0028 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC MedicareMax Medicare Advantage FL-0028 (HMO) in 2026, please refer to our full plan details page.
UHC MedicareMax Medicare Advantage FL-0028 (HMO) is a HMO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Miami-Dade County. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that UHC MedicareMax Medicare Advantage FL-0028 (HMO) 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 UHC MedicareMax Medicare Advantage FL-0028 (HMO).
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 UHC MedicareMax Medicare Advantage FL-0028 (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $13.00. You must continue to pay paying your reduced 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3900.00 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 UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan features a $0 drug deductible, allowing your prescription drug coverage to begin immediately. Members pay no copay for Tier 1 preferred generic and Tier 2 generic medications for both 1-month and 3-month supplies at standard pharmacies and through mail order. This ensures low-cost access to essential everyday medications. For Tier 3 preferred brand drugs, standard pharmacy copays are $25 for a 1-month supply and $75 for a 3-month supply, though preferred mail order reduces the 3-month cost to a $65 copay. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs at 40% coinsurance and Tier 5 specialty drugs at 33% coinsurance for a 1-month supply.
Additional Benefits
The UHC MedicareMax Medicare Advantage FL-0028 (HMO) offers comprehensive coverage with no copay and no coinsurance for many essential services, including inpatient hospital stays, primary care, specialist visits, and home health care. Members also benefit from no copay and no coinsurance on routine dental care, annual vision exams with a $300 eyewear allowance, and yearly hearing exams. For urgent and emergency situations, the plan features a $150 copay for emergency room visits and a $90 copay for ambulance services, both with no coinsurance. While many diagnostic tests, outpatient surgeries, and over-the-counter items feature no copay, other medical services require cost-sharing. For instance, dialysis, chemotherapy drugs, and prosthetic devices require a 20% coinsurance, while skilled nursing facility stays require a $218 daily copay for days 21 through 100. Additionally, the plan provides up to 60 free one-way transportation trips per year to approved locations to help you easily access care.
Inpatient Hospital See details
Inpatient hospital services are partially covered by UHC MedicareMax Medicare Advantage FL-0028 (HMO), featuring no copay and no coinsurance for Medicare-covered acute and psychiatric stays. However, non-Medicare-covered stays, upgrades for acute stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Outpatient services are covered by UHC MedicareMax Medicare Advantage FL-0028 (HMO) with no coinsurance, featuring a copay of $0 to $150 for outpatient hospital services and $150 per day for observation services. Ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
The UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
UHC MedicareMax Medicare Advantage FL-0028 (HMO) covers ground and air ambulance services with a $90 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 60 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by UHC MedicareMax Medicare Advantage FL-0028 (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $0 to $5 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
UHC MedicareMax Medicare Advantage FL-0028 (HMO) covers primary care, specialist visits, physical therapy, mental health, and telehealth services with no copay and no coinsurance. Chiropractic services are not covered by this plan, while routine podiatry is covered for up to six visits per year with no copay and no coinsurance.
Preventive Services See details
UHC MedicareMax Medicare Advantage FL-0028 (HMO) provides partially covered preventive services with no copay and no coinsurance for covered services, which include annual physical exams, fitness benefits, home safety devices, and kidney disease education. However, several sub-services are not covered, including 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 the UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan, featuring no copay or coinsurance for one routine annual hearing exam, while fitting and evaluation services are not covered. Up to two prescription hearing aids per year are available with a $199 to $1,249 copay, and up to two OTC hearing aids are available with a $199 to $829 copay, both with no coinsurance, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
UHC MedicareMax Medicare Advantage FL-0028 (HMO) provides partially covered vision services with no copay and no coinsurance, which includes one routine eye exam per year and a $300 annual maximum for contact lenses, eyeglasses (lenses and frames), and upgrades. Other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by UHC MedicareMax Medicare Advantage FL-0028 (HMO) with no copay and no coinsurance for covered benefits like oral exams, cleanings, x-rays, fluoride, restorative care, removable prosthodontics, and oral surgery. Sub-services not covered under this plan include other diagnostic and preventive services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC MedicareMax Medicare Advantage FL-0028 (HMO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, such as chemotherapy, carry a coinsurance of up to 20% with no copay, while insulin requires a $35 copay and up to 20% coinsurance.
Dialysis Services See details
UHC MedicareMax Medicare Advantage FL-0028 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
UHC MedicareMax Medicare Advantage FL-0028 (HMO) covers durable medical equipment, medical supplies, and diabetic supplies with no copay and no coinsurance. Prosthetic devices and diabetic therapeutic shoes or inserts are covered with a 20% coinsurance, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
UHC MedicareMax Medicare Advantage FL-0028 (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members pay no copay for lab services, diagnostic tests, outpatient X-rays, and diagnostic radiology, while therapeutic radiological services require a $10 copay.
Home Health Services See details
UHC MedicareMax Medicare Advantage FL-0028 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the UHC MedicareMax Medicare Advantage FL-0028 (HMO) plan, as all rehabilitation sub-services—including intensive cardiac, pulmonary, and SET for PAD—are excluded.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by UHC MedicareMax Medicare Advantage FL-0028 (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 copayment for days 21 through 100, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
UHC MedicareMax Medicare Advantage FL-0028 (HMO) provides partial coverage for Other Services, as acupuncture is not covered. Covered benefits include Over-the-Counter (OTC) items and chronic illness meals, both offered with no copay and no coinsurance, though meal benefits require prior authorization.
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