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AARP Medicare Advantage Essentials from UHC KC-4 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage Essentials from UHC KC-4 (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 Essentials from UHC KC-4 (PPO) in 2025, please refer to our full plan details page.
AARP Medicare Advantage Essentials from UHC KC-4 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Kansas and Missouri. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that AARP Medicare Advantage Essentials from UHC KC-4 (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 Essentials from UHC KC-4 (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 Essentials from UHC KC-4 (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 $340.00 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 $6200.00 (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 $6200.00 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 Essentials from UHC KC-4 (PPO) plan has a $340 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you may pay an $8 copay for a preferred generic drug at a standard pharmacy, or 29% coinsurance for a non-preferred drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The AARP Medicare Advantage Essentials from UHC KC-4 (PPO) plan offers a wide range of benefits with varying costs. This plan covers inpatient hospital stays with a copay, and outpatient services with copays depending on the service. Emergency services, including worldwide emergency services, have no copay. The plan offers no copay for primary care, preventive services including eye exams and dental cleanings, and home health services. Hearing exams have no copay, and hearing aids have a copay. Vision services include eye exams and eyewear with no copay. Additionally, the plan covers dental services, home infusion, dialysis, medical equipment, and diagnostic and radiological services with varying costs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $295 copay for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute have no copay for days 91-999, while 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.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $295, observation services have a $295 copay, and ambulatory surgical center services and outpatient blood services have no copay. Outpatient substance abuse individual sessions have a copay between $0 and $25, and group sessions have a $15 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the AARP Medicare Advantage Essentials from UHC KC-4 (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AARP Medicare Advantage Essentials from UHC KC-4 (PPO) plan. Ground and air ambulance services have a $290 copay, with no coinsurance. 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 Essentials from UHC KC-4 (PPO) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a copay between $0-$65; there is no coinsurance for either service. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, have no copay.
Primary Care See details
The AARP Medicare Advantage Essentials from UHC KC-4 (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a copay between $0 and $25, while specialist services, mental health, and podiatry services have a copay between $0 and $25. Physical therapy and speech-language pathology services have a copay between $0 and $25, and additional telehealth benefits have no copay.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services with a copay. Also covered are kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Some services, such as health education, in-home safety assessments, and counseling services, are not covered.
Hearing Services See details
Hearing exams are covered with no copay, while fitting/evaluation for hearing aids are not covered. Prescription hearing aids are covered with a copay between $199 and $1249, and OTC hearing aids are covered with a copay between $99 and $829.
Vision Services See details
The AARP Medicare Advantage Essentials from UHC KC-4 (PPO) plan covers vision services including eye exams and eyewear. Eye exams have no copay, and routine eye exams are limited to one per year. Eyewear, including contact lenses, eyeglass lenses, and eyeglass frames, are covered with no copay, but eyeglass frames are limited to one every two years, and there is a combined maximum benefit of $300 for all eyewear every two years. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include a 20% coinsurance for Medicare dental services, and no copay for oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, although some services are limited to a certain number of visits per year. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the AARP Medicare Advantage Essentials from UHC KC-4 (PPO) plan. This plan requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with 20% coinsurance and no copay, prosthetics and medical supplies with no copay and a 20% coinsurance for covered services, and diabetic equipment. Diabetic supplies have no copay, and diabetic therapeutic shoes/inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a $50 copay, and lab services with no copay. Radiological services are covered, including diagnostic radiological services with a copay up to $180, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $25 copay.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage Essentials from UHC KC-4 (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 the plan does not cover the sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with prior authorization required. There is no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
Other Services are covered by the AARP Medicare Advantage Essentials from UHC KC-4 (PPO) plan, but acupuncture, 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. Over-the-Counter (OTC) Items and Meal Benefits are covered with no copay.
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