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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 2026, 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 3.5 out of 5 stars in 2026.
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 $45.00. 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 $13900.00 (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 $13900.00 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 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 a standard pharmacy, or for a 3-month supply via mail order. Tier 2 generic drugs cost a $12 copay for a 1-month supply at a standard pharmacy, but you can get a 3-month supply with no copay through preferred mail order. For higher-tier medications, this Medicare Advantage plan transitions to coinsurance. Tier 3 preferred brand drugs require a 15% coinsurance for both standard pharmacy and mail-order options. Tier 4 non-preferred drugs carry a 38% coinsurance, while Tier 5 specialty medications require a 26% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC NJ-0004 (PPO) plan offers robust coverage for essential medical services, with many benefits requiring no copay and no coinsurance, including primary care visits, preventive care, and home health services. For inpatient hospital stays, members pay a $485 daily copay for the first few days, after which there is no copay. Specialist visits range from no copay to a $50 copay, while emergency services carry a $115 copay that is waived upon hospital admission. Routine vision and hearing exams are covered with no copay, though prescription hearing aids and certain lenses require copays. Preventive dental care, diabetic supplies, and over-the-counter items are also covered with no copay and no coinsurance. However, durable medical equipment, dialysis services, and Medicare-covered dental care require a 20% coinsurance.
Inpatient Hospital See details
AARP Medicare Advantage from UHC NJ-0004 (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute stays require a $485 daily copay for days 1-5 (with no copay for days 6 and beyond) and psychiatric stays require a $485 daily copay for days 1-4 (with no copay for days 5-90), but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC NJ-0004 (PPO) covers outpatient services with no coinsurance, though copays apply to certain services and prior authorization is generally required. You will pay no copay for ambulatory surgical center and outpatient blood services, while outpatient hospital services range from no copay up to a $485 copay, and outpatient substance abuse sessions carry copays up to $25.
Partial Hospitalization See details
AARP Medicare Advantage from UHC NJ-0004 (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC NJ-0004 (PPO) covers Medicare-approved ground and air ambulance services with a $275 copay and no coinsurance per service, subject to prior authorization. Routine transportation services to health-related locations are not covered by this plan.
Emergency Services See details
AARP Medicare Advantage from UHC NJ-0004 (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services have a copay of $0 to $40 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
AARP Medicare Advantage from UHC NJ-0004 (PPO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits have a $0 to $50 copay and no coinsurance. Physical therapy, occupational therapy, and mental health services are also covered with no coinsurance and copays ranging from $0 to $50, though chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by AARP Medicare Advantage from UHC NJ-0004 (PPO) with no copay and no coinsurance, including annual physicals, fitness benefits, and home safety devices. The benefit is partially covered because sub-services like 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 are not covered.
Hearing Services See details
Hearing services are covered by AARP Medicare Advantage from UHC NJ-0004 (PPO) with no deductibles and no coinsurance, including one annual routine hearing exam with no copay. Prescription hearing aids (up to two per year) carry a $199 to $1,249 copay, while up to two OTC hearing aids are covered with a $199 to $829 copay. Note that hearing aid fittings and evaluations, along with inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
AARP Medicare Advantage from UHC NJ-0004 (PPO) partially covers vision services with no deductibles and no coinsurance, providing one routine eye exam per year with no copay. Covered eyewear includes contact lenses and frames with no copay, and eyeglass lenses with a $0 to $153 copay up to a combined $150 limit every two years, while other eye exams, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
AARP Medicare Advantage from UHC NJ-0004 (PPO) provides partially covered dental services, featuring no copay and 20% coinsurance for Medicare-covered dental care, alongside preventive care like exams and cleanings with no copay and no coinsurance. However, comprehensive dental services such as restorative care, endodontics, periodontics, prosthodontics, implants, orthodontics, and oral surgery are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by AARP Medicare Advantage from UHC NJ-0004 (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
AARP Medicare Advantage from UHC NJ-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
AARP Medicare Advantage from UHC NJ-0004 (PPO) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance. Covered diabetic supplies have no copay, while diabetic therapeutic shoes or inserts carry a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
AARP Medicare Advantage from UHC NJ-0004 (PPO) covers diagnostic and radiological services, offering lab services and diagnostic radiological services with no copay. Diagnostic procedures require a $55 copay with no coinsurance, while outpatient X-rays have a $30 copay and therapeutic radiological services require a 20% coinsurance.
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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the AARP Medicare Advantage from UHC NJ-0004 (PPO) with no copay and no coinsurance, requiring prior authorization. Although some services are covered, 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
Skilled Nursing Facility (SNF) care is covered by AARP Medicare Advantage from UHC NJ-0004 (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
AARP Medicare Advantage from UHC NJ-0004 (PPO) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires prior authorization.
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