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AARP Medicare Advantage from UHC IL-0004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC IL-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 IL-0004 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC IL-0004 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Chicago Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that AARP Medicare Advantage from UHC IL-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 IL-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 IL-0004 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $68.00. 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 IL-0004 (PPO) prescription drug coverage features an annual drug deductible of $600. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through mail order. Tier 2 generic drugs cost a $12 copay for a 1-month supply at standard pharmacies, but you can enjoy no copay for a 3-month supply when choosing preferred mail order. For brand-name and specialty medications, costs are based on coinsurance instead of flat copays. Tier 3 preferred brand drugs require a 15% coinsurance for standard pharmacy and mail order fills. Tier 4 non-preferred drugs carry a 41% coinsurance, while Tier 5 specialty drugs require a 26% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC IL-0004 (PPO) plan provides affordable healthcare coverage, featuring no copay and no coinsurance for primary care visits, telehealth, annual physicals, and home health services. For advanced medical needs, members face a $130 copay for emergency room visits and a $455 daily copay for the first six days of acute inpatient hospital stays. Outpatient services and specialist visits are also covered, with specialist copays capped at $55 and diagnostic lab tests requiring no copay. Supplemental benefits include routine dental and vision exams with no copay, though comprehensive dental care carries a 50% coinsurance up to a $1,000 annual maximum. Hearing care features no copay for annual exams, with prescription hearing aids requiring copays between $199 and $1,249. Additionally, durable medical equipment features a 20% coinsurance, while skilled nursing facility stays require no copay for the first 20 days of care.
Inpatient Hospital See details
AARP Medicare Advantage from UHC IL-0004 (PPO) covers inpatient hospital services with no coinsurance, requiring a $455 daily copay for days 1 to 6 of acute stays (with no copay for days 7 and beyond) and a $455 daily copay for days 1 to 5 of psychiatric stays (with no copay for days 6 to 90). These benefits require prior authorization and are partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC IL-0004 (PPO) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $455, including a $455 daily copay for observation services, while outpatient substance abuse individual sessions have a $0 to $25 copay and group sessions have a $15 copay.
Partial Hospitalization See details
AARP Medicare Advantage from UHC IL-0004 (PPO) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance services are covered by AARP Medicare Advantage from UHC IL-0004 (PPO) with a $275 copay and no coinsurance for both ground and air transportation, which require prior authorization. For transportation benefits, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
AARP Medicare Advantage from UHC IL-0004 (PPO) covers emergency services with a $130 copay and no coinsurance, which is 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 covered with no copays or coinsurance.
Primary Care See details
Primary Care benefits for the AARP Medicare Advantage from UHC IL-0004 (PPO) plan are covered with no copay and no coinsurance for primary care visits and telehealth, while specialist visits and therapy services range from no copay up to a $55 copay with no coinsurance. Chiropractic services are only partially covered as routine chiropractic care is not covered, and prior authorization is required for most specialty services.
Preventive Services See details
AARP Medicare Advantage from UHC IL-0004 (PPO) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, fitness benefits, 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, post-discharge medication reconciliation, re-admission 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, and counseling.
Hearing Services See details
Hearing services are partially covered by the AARP Medicare Advantage from UHC IL-0004 (PPO) plan, featuring no coinsurance for all covered benefits and no copay for one annual routine hearing exam. Prescription hearing aids (up to two yearly) have copays ranging from $199.00 to $1,249.00, and up to two OTC hearing aids have copays of $199.00 to $829.00. Fitting and evaluation exams, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services are partially covered by the AARP Medicare Advantage from UHC IL-0004 (PPO) plan, featuring no copay and no coinsurance for routine eye exams and covered eyewear. While contact lenses, eyeglass frames, and eyeglass lenses (with copays ranging from $0 to $153) are covered up to a $250 combined limit every two years, other eye exams, complete eyeglass packages, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under the AARP Medicare Advantage from UHC IL-0004 (PPO), excluding implant services and orthodontics. Preventive dental care has no copay and no coinsurance, while Medicare-covered services have a 20% coinsurance and comprehensive services have a 50% coinsurance (both with no copay) up to a $1,000 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by AARP Medicare Advantage from UHC IL-0004 (PPO) with no copay, subject to prior authorization. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
AARP Medicare Advantage from UHC IL-0004 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, is covered by AARP Medicare Advantage from UHC IL-0004 (PPO) with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay and no coinsurance, while diabetic therapeutic shoes and inserts are covered with no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC IL-0004 (PPO) covers diagnostic and radiological services, which require prior authorization. Diagnostic lab services have no copay and no coinsurance, diagnostic tests have a $50 copay with no coinsurance, and outpatient x-rays carry a $30 copay. Diagnostic radiological services feature copays starting at $0, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
AARP Medicare Advantage from UHC IL-0004 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by the AARP Medicare Advantage from UHC IL-0004 (PPO) with no copay, no coinsurance, and prior authorization required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC IL-0004 (PPO) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a 3-day hospital stay is not required before admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by AARP Medicare Advantage from UHC IL-0004 (PPO), featuring over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. While prior authorization is required for the meal benefit, acupuncture is not covered under this plan.
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