UHC MedicareDirect PF-0001 (PFFS)

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 2.5 out of 5 stars in 2026.

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.

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:

Drug Coverage

The UHC MedicareDirect PF-0001 (PFFS) plan features an annual drug deductible of $600. For Tier 1 preferred generic drugs, you will pay no copay for standard pharmacy fills or three-month mail orders. Tier 2 generic drugs are also highly affordable, offering no copay for a three-month preferred mail order and a $14 copay for a one-month supply at a standard pharmacy. Brand-name and specialty drugs require coinsurance instead of a copayment during the initial coverage phase. Tier 3 preferred brand drugs carry a 16% coinsurance, while Tier 4 non-preferred drugs require 36% coinsurance. Specialty medications in Tier 5 are covered with a 26% coinsurance for a one-month supply across standard pharmacies and mail-order options.

Additional Benefits

The UHC MedicareDirect PF-0001 (PFFS) plan offers robust medical coverage with predictable out-of-pocket costs, featuring no copays for home health services and primary care visits ranging from no copay to $25. Specialist visits require a copay of up to $55, while inpatient hospital stays incur a $525 daily copay for the first five days of acute stays with no coinsurance. Emergency care is available with a $130 copay, which is waived upon admission, and urgent care ranges from no copay to a $50 copay. For routine care, this plan provides preventive dental, routine eye exams, and over-the-counter hearing aids with no copays, though comprehensive dental and durable medical equipment require a 20% to 50% coinsurance. Skilled nursing facility stays feature no copay for the first 20 days, and diagnostic lab services are fully covered with no copay or coinsurance. It is important to note that certain services, including cardiac rehabilitation, fitness programs, and acupuncture, are not covered under this plan.