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AARP Medicare Advantage from UHC NJ-0004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NJ-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 NJ-0004 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage from UHC NJ-0004 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of New Jersey. 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 NJ-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 NJ-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 NJ-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. 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 $14000.00 (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 $14000.00 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 NJ-0004 (PPO) plan has a $420 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $12 copay for a standard generic drug at a standard pharmacy. For preferred brand drugs, the copay is $100.00. Once your total drug costs reach $2000.00, you enter the next coverage phase, where you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The AARP Medicare Advantage from UHC NJ-0004 (PPO) plan offers a range of benefits, including inpatient hospital stays with a $390 copay, and outpatient services with varying copays depending on the service. Emergency and urgent care services have copays, with worldwide emergency coverage at no cost. The plan also covers primary care with no copay, and specialist visits with a copay. Preventive services, such as annual physical exams, have no copay, and hearing exams are also covered with no copay. Vision services include eye exams and eyewear with no copay, while dental services cover preventive care with no copay. The plan covers home health services with no copay, and offers additional benefits like over-the-counter items and a meal benefit, both with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with prior authorization. For Inpatient Hospital-Acute, you will pay a $390 copay for days 1-6, and no copay for days 7-90, and no copay for days 91-999. For Inpatient Hospital Psychiatric, you will pay a $390 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $390, observation services with a $390 copay per day, ambulatory surgical center 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 of these services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AARP Medicare Advantage from UHC NJ-0004 (PPO) plan. Ground and Air Ambulance Services each have a copay of $275, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the AARP Medicare Advantage from UHC NJ-0004 (PPO) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a copay between $0 and $45, and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay and no coinsurance.
Primary Care See details
The AARP Medicare Advantage from UHC NJ-0004 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a copay between $0 and $25. It also covers physician specialist services with a copay between $0 and $40, mental health specialty services, podiatry services with a $40 copay, other healthcare professional services, psychiatric services, and physical therapy and speech-language pathology services with a copay between $0 and $25. The plan also covers additional telehealth benefits and opioid treatment program services with no copay.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, as well as an annual physical exam with no copay. Additional preventive services are covered, including Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Other services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are covered once per year. Prescription hearing aids are partially covered, with copays ranging from $199 to $1249, and OTC hearing aids are covered with a copay between $99 and $829. Fitting/evaluation for hearing aids, prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams, eyewear, and contact lenses. Eye exams and eyewear have no copay, and eyeglass lenses have a copay between $0.00 and $153.00; however, eyeglass frames and upgrades are not covered. Contact lenses are unlimited, and there is a combined maximum of $250.00 for all eyewear every two years.
Dental Services See details
Dental Services include coverage for Medicare dental services with 20% coinsurance, oral exams, dental X-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Orthodontic, restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage from UHC NJ-0004 (PPO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for diagnostic procedures and tests with a copay of $50, lab services with no copay, diagnostic radiological services with a copay up to $195, therapeutic radiological services with coinsurance up to 20%, and outpatient X-ray services with a $40 copay.
Home Health Services See details
Home Health Services are covered by AARP Medicare Advantage from UHC NJ-0004 (PPO) with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required, and the copay information can be found below.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AARP Medicare Advantage from UHC NJ-0004 (PPO), with a $0 copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and a Meal Benefit. Over-the-Counter (OTC) Items have no copay, and the Meal Benefit also has no copay, but requires prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other sub-services are not covered.
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