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AARP Medicare Advantage from UHC WV-0003 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC WV-0003 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AARP Medicare Advantage from UHC WV-0003 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC WV-0003 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of West Virginia. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage from UHC WV-0003 (PPO) 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 from UHC WV-0003 (PPO).
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 from UHC WV-0003 (PPO), 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 has a $1500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page 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 AARP Medicare Advantage from UHC WV-0003 (PPO) plan features an annual drug deductible of $520. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies, as well as for 3-month mail orders. Tier 2 generic drugs cost a $12 copay for a 1-month standard pharmacy supply, though you can get a 3-month supply with no copay through preferred mail order. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 16% coinsurance for standard pharmacy and mail-order fills. Tier 4 non-preferred drugs carry a 39% coinsurance, while Tier 5 specialty drugs require a 27% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC WV-0003 (PPO) plan offers robust coverage for essential medical needs, featuring no copay and no coinsurance for primary care visits, telehealth, preventive care, and home health services. For inpatient hospital stays, members pay a $325 daily copay for days 1 through 5, with no copay for days 6 through 90. Emergency room visits carry a $130 copay, which is waived if admitted, while specialist visits range from no copay to a $55 copay. This plan also includes valuable supplemental benefits, such as no copay for annual routine vision and hearing exams, alongside a $300 eyewear allowance every two years. While routine dental services are not covered, Medicare-covered dental procedures, dialysis, and durable medical equipment are subject to a 20% coinsurance with no copay. Additionally, diagnostic labs and diagnostic radiology require no copay, helping to keep out-of-pocket costs low for key diagnostic services.
Inpatient Hospital See details
Inpatient hospital services are covered by AARP Medicare Advantage from UHC WV-0003 (PPO) with no coinsurance, requiring a $325 daily copay for days 1-5 and no copay for days 6-90 per stay. This benefit is partially covered, as additional psychiatric days, hospital upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC WV-0003 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $325 copay for outpatient hospital services and a $325 daily copay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse services carry a $0 to $25 copay with no coinsurance.
Partial Hospitalization See details
AARP Medicare Advantage from UHC WV-0003 (PPO) covers partial hospitalization with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by AARP Medicare Advantage from UHC WV-0003 (PPO), featuring a $275 copay and no coinsurance for ground and air ambulance services, which require prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
AARP Medicare Advantage from UHC WV-0003 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a copay ranging from $0 to $50 with no coinsurance, and worldwide emergency, urgent, and transportation services are fully covered with no copay and no coinsurance.
Primary Care See details
Primary Care benefits under the AARP Medicare Advantage from UHC WV-0003 (PPO) feature no copay and no coinsurance for primary care provider visits and telehealth services. Specialist visits range from a $0 to $55 copay with no coinsurance, physical and occupational therapies require a $50 to $55 copay with no coinsurance, and chiropractic services are not covered in practice.
Preventive Services See details
AARP Medicare Advantage from UHC WV-0003 (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, fitness benefits, glaucoma screenings, and diabetes self-management training. This benefit is partially covered because several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety modifications, and counseling.
Hearing Services See details
AARP Medicare Advantage from UHC WV-0003 (PPO) partially covers hearing services, offering one routine hearing exam per year with no copay and no coinsurance, though fitting and evaluation exams are not covered. Up to two prescription hearing aids (copays of $199.00 to $1,249.00) and two OTC hearing aids (copays of $199.00 to $829.00) are covered annually with no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by AARP Medicare Advantage from UHC WV-0003 (PPO), featuring no coinsurance and no copay for one routine eye exam yearly, though other eye exams are not covered. Eyewear is covered up to a $300 combined limit every two years with no coinsurance, offering contact lenses and frames with no copay, and eyeglass lenses with a $0 to $153 copay. Upgrades and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage from UHC WV-0003 (PPO) partially covers dental services, offering coverage for Medicare-covered dental procedures with no copay and a 20% coinsurance. Routine and comprehensive dental services, such as cleanings, exams, x-rays, and restorative treatments, are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by AARP Medicare Advantage from UHC WV-0003 (PPO) with no copay, though prior authorization is required. Under this benefit, Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by AARP Medicare Advantage from UHC WV-0003 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by AARP Medicare Advantage from UHC WV-0003 (PPO), featuring no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are available with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC WV-0003 (PPO) covers diagnostic and radiological services with prior authorization. Diagnostic tests require a $50 copay and no coinsurance, lab services and diagnostic radiology have no copay and no coinsurance, outpatient X-rays have a $30 copay, and therapeutic radiology has a 20% coinsurance.
Home Health Services See details
The AARP Medicare Advantage from UHC WV-0003 (PPO) plan 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 AARP Medicare Advantage from UHC WV-0003 (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC WV-0003 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
AARP Medicare Advantage from UHC WV-0003 (PPO) partially covers other services, providing a meal benefit for chronic illnesses with no copay and no coinsurance, subject to prior authorization. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered under this benefit.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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