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AARP Medicare Advantage from UHC IL-5 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC IL-5 (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-5 (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
AARP Medicare Advantage from UHC IL-5 (PPO) is a PPO plan offered by Care Improvement Plus South Central Insurance Co. available for the 2026 plan year to people living in Select Counties in Illinois. 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-5 (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-5 (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-5 (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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6700.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6700.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $10100.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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-5 (PPO) plan features an annual drug deductible of $600. For Tier 1 preferred generic drugs, there is no copay for standard pharmacy fills or mail-order options. Tier 2 generic drugs carry a $14 copay for a one-month standard pharmacy supply, but you will pay no copay for a three-month supply filled via preferred mail order. Higher-tier medications require coinsurance instead of flat copays during the initial coverage phase. Tier 3 preferred brand drugs carry a 15% coinsurance, while Tier 4 non-preferred drugs require 34% coinsurance. Tier 5 specialty drugs are subject to a 26% coinsurance rate at standard pharmacies as well as through mail-order services.
Additional Benefits
The AARP Medicare Advantage from UHC IL-5 (PPO) plan offers robust coverage with no copay or coinsurance for primary care visits, telehealth, annual physicals, and routine preventive services. For specialized care, specialist visits require a copay ranging from no copay up to $60, while outpatient hospital services feature a copay of up to $550 with no coinsurance. If you require inpatient hospital care, you will pay a daily copay of $550 for the first five days of acute stays, with no copay for subsequent days. Emergency room visits require a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Routine hearing and vision exams, as well as preventive dental services, are available with no copay and no coinsurance, though major dental care is not covered. Additionally, durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by AARP Medicare Advantage from UHC IL-5 (PPO) with no coinsurance, requiring a daily copay of $550 for days 1-5 of acute stays (with no copay for days 6 and beyond) and $550 for days 1-4 of psychiatric stays (with no copay for days 5-90). This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by AARP Medicare Advantage from UHC IL-5 (PPO) with no coinsurance, featuring a $0 to $550 copay for outpatient hospital services and a $550 daily copay for observation services. Ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a copay of $0 to $25 for individual visits and $15 for group visits.
Partial Hospitalization See details
AARP Medicare Advantage from UHC IL-5 (PPO) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC IL-5 (PPO) covers Medicare-covered ground and air ambulance services with a $275 copay and no coinsurance, subject to prior authorization. Although some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
AARP Medicare Advantage from UHC IL-5 (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 require a copay of $0 to $50 with 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 IL-5 (PPO) feature no copay and no coinsurance for primary care provider visits and telehealth services. Specialist visits require a $0 to $60 copay, physical, occupational, and speech therapies have a $50 to $60 copay, and podiatry has a $45 copay, all with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by AARP Medicare Advantage from UHC IL-5 (PPO) with no copay and no coinsurance for annual physicals, fitness benefits, safety devices, and select screenings. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC IL-5 (PPO), which offers one routine hearing exam per year with no copay and no coinsurance, but does not cover fitting and evaluation exams. Up to two prescription or OTC hearing aids are covered annually with no coinsurance and copays ranging from $199.00 to $1,249.00, though 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 IL-5 (PPO), offering one routine eye exam per year and contact lenses with no copay and no coinsurance. Eyeglass frames are covered with no copay and no coinsurance, and eyeglass lenses have a copay of $0 to $153 and no coinsurance up to a combined $250 benefit limit every two years, but upgrades, other eye exams, and bundled eyeglasses are not covered.
Dental Services See details
AARP Medicare Advantage from UHC IL-5 (PPO) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance, and preventive services like cleanings and exams with no copay and no coinsurance. Major dental services, including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by AARP Medicare Advantage from UHC IL-5 (PPO) with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
AARP Medicare Advantage from UHC IL-5 (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
AARP Medicare Advantage from UHC IL-5 (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage from UHC IL-5 (PPO), requiring prior authorization for all services. Diagnostic tests incur a $50 copay with no coinsurance, lab services have no copay or coinsurance, and radiological services range from a $0 copay with no coinsurance for diagnostic imaging to a $30 copay and coinsurance for X-rays and a 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered by AARP Medicare Advantage from UHC IL-5 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the AARP Medicare Advantage from UHC IL-5 (PPO) plan, as all sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET), are excluded from coverage in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AARP Medicare Advantage from UHC IL-5 (PPO) 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, a prior three-day hospital stay is not required for admission, and additional days beyond the Medicare-covered 100-day limit are not covered.
Other Services See details
Other services are partially covered under the AARP Medicare Advantage from UHC IL-5 (PPO), which provides over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, though prior authorization is required for meals. Acupuncture is not covered under this plan.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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