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UHC MedicareDirect PF-0001 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC MedicareDirect PF-0001 (PFFS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC MedicareDirect PF-0001 (PFFS) in 2025, please refer to our full plan details page.
UHC MedicareDirect PF-0001 (PFFS) is a PFFS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in KS, MT, and WY. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that UHC MedicareDirect PF-0001 (PFFS) 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 MedicareDirect PF-0001 (PFFS).
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 MedicareDirect PF-0001 (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $82.00. 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
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below for more information.
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 MedicareDirect PF-0001 (PFFS) plan has an enhanced alternative drug benefit. The plan has a deductible of $495.00. After the deductible, you will pay a copay for your prescriptions, depending on the drug tier and pharmacy. For example, you will pay a $14.00 copay for a standard generic drug at a standard pharmacy, and a $100.00 copay for a preferred brand drug. Once your total drug costs reach $2000.00, you enter the next coverage phase.
Additional Benefits
The UHC MedicareDirect PF-0001 (PFFS) plan offers a range of benefits with varying costs. This plan provides coverage for inpatient hospital stays, with a copay, and outpatient services, with copays. This plan also includes coverage for primary care, preventive services, hearing, vision, and dental services, with some services incurring copays or coinsurance. The plan covers ambulance, emergency services, home health, and skilled nursing facility stays, but cardiac rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $525 copay for days 1-5, and no copay for days 6-90; additional days 91-999 have no copay. For Inpatient Hospital Psychiatric, you'll pay a $525 copay for days 1-4, and no copay for days 5-90; additional days are not covered.
Outpatient Services See details
Outpatient Services for UHC MedicareDirect PF-0001 (PFFS) includes coverage for Outpatient Hospital Services with a copay between $0 and $525, Observation Services with a $525 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual Sessions for Outpatient Substance Abuse with a copay between $0 and $25, Group Sessions for Outpatient Substance Abuse with a $15 copay, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the UHC MedicareDirect PF-0001 (PFFS) plan. Ground and Air Ambulance Services have a $290 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the UHC MedicareDirect PF-0001 (PFFS) plan with a $125 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $55, with no coinsurance. Worldwide Emergency Services are covered, with no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The UHC MedicareDirect PF-0001 (PFFS) plan covers primary care physician services with a copay between $0 and $25, chiropractic services with a $20 copay, and occupational therapy services with a copay between $0 and $45. The plan also covers physician specialist services with a copay between $0 and $55, mental health specialty services, podiatry services with a $45 copay, other health care professional services with a copay between $0 and $55, psychiatric services, physical therapy and speech-language pathology services with a copay between $0 and $50, additional telehealth benefits with no copay, and opioid treatment program services with no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
The UHC MedicareDirect PF-0001 (PFFS) plan covers preventive services, including an annual physical exam with no copay. 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. However, some services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing Services includes Hearing Exams, Prescription Hearing Aids, and OTC Hearing Aids. Hearing Exams have a $20 copay, while Routine Hearing Exams have a $0 copay and Fitting/Evaluation for Hearing Aid is not covered. Prescription Hearing Aids are covered with a maximum plan benefit of $1500 every year, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC Hearing Aids have no copay.
Vision Services See details
The UHC MedicareDirect PF-0001 (PFFS) plan covers vision services, including eye exams and eyewear. Eye exams and contact lenses have no copay, while eyeglasses (lenses and frames) have no copay, but the plan has a combined maximum benefit of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The UHC MedicareDirect PF-0001 (PFFS) plan covers dental services, with a 20% coinsurance for Medicare Dental Services. Other dental services are covered, with a $500 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no copay. Prosthodontics (removable and fixed) has a coinsurance between 0% and 50%. Orthodontic and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC MedicareDirect PF-0001 (PFFS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies, which have a 20% coinsurance and no copay for Medicare-covered supplies. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a $50 copay, and lab services with no copay. Radiological services include coverage for diagnostic radiological services with a copay up to $250, therapeutic radiological services with a coinsurance of at least 20%, and outpatient X-ray services with a $25 copay.
Home Health Services See details
Home Health Services are covered by the UHC MedicareDirect PF-0001 (PFFS) 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 not covered by the UHC MedicareDirect PF-0001 (PFFS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UHC MedicareDirect PF-0001 (PFFS), with no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are covered by the UHC MedicareDirect PF-0001 (PFFS) plan, but Acupuncture, Over-the-Counter (OTC) Items, Meal Benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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