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AARP Medicare Advantage from UHC WV-0004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC WV-0004 (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-0004 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC WV-0004 (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-0004 (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-0004 (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-0004 (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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $600.00 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-0004 (PPO) plan features an annual prescription drug deductible of $600. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at a standard pharmacy, or for a 3-month mail-order supply. Tier 2 generic drugs require a $12 copay for a 1-month supply at standard pharmacies, though you can get a 3-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs are subject to a 16% coinsurance for both standard pharmacies and mail-order options. Higher-tier prescriptions require coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring 42% coinsurance and Tier 5 specialty drugs requiring 26% coinsurance for a 1-month supply. Understanding these tier-based costs can help you estimate your out-of-pocket drug expenses with this PPO plan.
Additional Benefits
The AARP Medicare Advantage from UHC WV-0004 (PPO) plan offers robust coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, telehealth, and annual preventive exams. For hospital stays, members pay a $455 daily copay for the first 5 to 6 days of inpatient care and no copay for subsequent days, while outpatient services range from no copay up to a $455 copay. Emergency room visits require a $130 copay, which is waived upon admission, and urgent care services feature a copay of $0 to $50. This plan also includes key supplemental benefits, providing routine hearing and vision exams with no copay, alongside allowances for eyewear and hearing aids. Preventive dental care and home health services are available with no copay and no coinsurance, though Medicare-covered dental services and durable medical equipment require a 20% coinsurance. Additionally, members benefit from skilled nursing facility care with no copay for the first 20 days and no-copay over-the-counter items.
Inpatient Hospital See details
AARP Medicare Advantage from UHC WV-0004 (PPO) covers inpatient hospital services with no coinsurance, requiring a $455 daily copay for days 1 through 6 for acute stays (days 1 through 5 for psychiatric stays) and no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC WV-0004 (PPO) covers outpatient hospital services with no coinsurance and a $0 to $455 copay, and outpatient observation services with no coinsurance and a $455 daily copay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services feature no coinsurance and copays ranging from $0 to $25.
Partial Hospitalization See details
AARP Medicare Advantage from UHC WV-0004 (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by AARP Medicare Advantage from UHC WV-0004 (PPO), offering ground and air ambulance services with a $290 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage from UHC WV-0004 (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay of $0 to $50 and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Primary care benefits under the AARP Medicare Advantage from UHC WV-0004 (PPO) offer primary care physician visits and telehealth services with no copay and no coinsurance. Other services feature no coinsurance, with copays ranging from $0 to $55 for specialists, $50 to $55 for physical, occupational, and speech therapies, and $0 to $25 for mental health sessions, though routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by AARP Medicare Advantage from UHC WV-0004 (PPO) with no copay and no coinsurance for covered services like annual exams, fitness benefits, and kidney education. Sub-services that are not covered include health education, PERS, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
AARP Medicare Advantage from UHC WV-0004 (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. The plan also covers up to two prescription hearing aids (copay of $199 to $1,249) and up to two OTC hearing aids (copay of $199 to $829) annually with no coinsurance, while inner, outer, and over-the-ear prescription devices are not covered.
Vision Services See details
Vision Services are partially covered by AARP Medicare Advantage from UHC WV-0004 (PPO), featuring one annual routine eye exam with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no coinsurance up to a $150 combined limit every two years, with no copay for contacts and frames, and a $0 to $153 copay for lenses; upgrades and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage from UHC WV-0004 (PPO) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance, and preventive services with no copay and no coinsurance. However, restorative, endodontic, periodontic, prosthodontic, implant, oral and maxillofacial surgery, orthodontic, maxillofacial prosthetics, and adjunctive general services are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC WV-0004 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require no copay and a 0% to 20% coinsurance, while covered Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the AARP Medicare Advantage from UHC WV-0004 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by AARP Medicare Advantage from UHC WV-0004 (PPO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay, though prior authorization is required and manufacturer limitations apply.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC WV-0004 (PPO) covers diagnostic services with no coinsurance, requiring a $50 copay for tests and no copay for lab services. Radiological services are also covered, featuring a $30 copay for outpatient X-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by the AARP Medicare Advantage from UHC WV-0004 (PPO) plan 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-0004 (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-0004 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required before admission, and additional days beyond the standard 100 days are not covered.
Other Services See details
AARP Medicare Advantage from UHC WV-0004 (PPO) provides partial coverage for other services, which includes over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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