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AARP Medicare Advantage from UHC OH-0004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC OH-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 OH-0004 (PPO) in 2025, please refer to our full plan details page.
This summary reflects 2025 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 OH-0004 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for the 2025 plan year to people living in Select Counties in Ohio. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that AARP Medicare Advantage from UHC OH-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 OH-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 OH-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 $420.00 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 $5900.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5900.00 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:
Sign up for AARP Medicare Advantage from UHC OH-0004 (PPO)
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Drug Coverage
The AARP Medicare Advantage from UHC OH-0004 (PPO) plan has an enhanced alternative drug benefit. The plan has a $420 deductible. After the deductible is met, you will pay a copay for your prescriptions. For example, standard generic drugs have a $14 copay. Preferred and standard brand drugs have a $100 copay. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs.
Additional Benefits
The AARP Medicare Advantage from UHC OH-0004 (PPO) plan offers comprehensive coverage with varying cost-sharing. You'll pay a copay for inpatient hospital stays, outpatient services, and emergency services, but many services like primary care, preventive services, and home health services have no copay. This plan also includes coverage for hearing, vision, and dental services. Hearing exams and routine eye exams have no copay, and you'll pay a copay for hearing aids and eyewear. Dental services include no copay for preventive services, and 20% coinsurance for Medicare dental services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, you pay a $375 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $375 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $375, Observation Services with a $375 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by AARP Medicare Advantage from UHC OH-0004 (PPO), with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the AARP Medicare Advantage from UHC OH-0004 (PPO) plan. Ground and Air Ambulance Services have a $275 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the AARP Medicare Advantage from UHC OH-0004 (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $55. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The AARP Medicare Advantage from UHC OH-0004 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay (routine care is not covered), and occupational therapy services with a copay between $0 and $45. The plan also covers physician specialist services with a copay between $0 and $45, and mental health specialty services with a copay between $0 and $25 for individual sessions and $15 for group sessions. Podiatry services have a $40 copay, other health care professional services have a copay between $0 and $45, and psychiatric services have a copay between $0 and $25 for individual sessions and $15 for group sessions. Physical therapy and speech-language pathology services have a copay between $0 and $50, Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services with varying copays. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit are covered with no copay. Health education, in-home safety assessments, and other services are not covered.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are covered with no copay for one visit per year. Prescription hearing aids are covered with a copay between $199 and $1249 for two hearing aids every year, and OTC hearing aids are covered with a copay between $99 and $829. Fitting/Evaluation for Hearing Aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames with no copay for each service, and a combined maximum plan benefit of $300 every two years; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The AARP Medicare Advantage from UHC OH-0004 (PPO) plan covers Medicare dental services with 20% coinsurance and other dental services. Oral exams, dental X-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay, but some services have visit limits. Orthodontic, restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance with authorization required, while Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay of $40, Lab Services with no copay, Diagnostic Radiological Services with a maximum copay of $150, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $15 copay. Radiological Services require prior authorization.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage from UHC OH-0004 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AARP Medicare Advantage from UHC OH-0004 (PPO). There is no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
The AARP Medicare Advantage from UHC OH-0004 (PPO) plan's Other Services benefit covers meal benefits with no copay, but acupuncture, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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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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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