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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 2026, 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 3.5 out of 5 stars in 2026.
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 $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 $7400.00 (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 $7400.00 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 features an annual drug deductible of $600. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies or for 3-month mail-order refills. Tier 2 generic drugs require an $8 copay for a 1-month standard pharmacy supply, though you can receive a 3-month supply with no copay using preferred mail order. For brand-name and specialty medications, your costs are determined by coinsurance. Tier 3 preferred brand drugs require a 17% coinsurance for both standard pharmacies and mail orders. Tier 4 non-preferred drugs have a 41% coinsurance, while Tier 5 specialty drugs carry a 26% coinsurance for a 1-month supply across standard pharmacy and mail-order options.
Additional Benefits
The AARP Medicare Advantage Essentials from UHC KC-4 (PPO) offers comprehensive coverage featuring no copay and no coinsurance for primary care doctor visits, annual physical exams, and home health services. Specialist office visits range from no copay to a $35 copay, while emergency room visits require a $130 copay which is waived if you are admitted. For inpatient hospital stays, members pay a $455 daily copay for the first six days of acute stays and no copay for any additional days. Routine vision and hearing exams are covered with no copay, while prescription hearing aids and eyewear are available with copays or allowance limits. Major medical needs like durable medical equipment, dialysis, and Medicare Part B drugs require a 20% coinsurance and no copay. Skilled nursing facility care is also accessible, offering no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
AARP Medicare Advantage Essentials from UHC KC-4 (PPO) covers inpatient hospital services with no coinsurance, requiring a $455 daily copay for days 1-6 of acute stays (no copay for days 7 and beyond) and a $455 daily copay for days 1-5 of psychiatric stays (no copay for days 6-90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by AARP Medicare Advantage Essentials from UHC KC-4 (PPO) with no coinsurance, although prior authorization is required. There is no copay for ambulatory surgical center and outpatient blood services, while outpatient hospital copays range from $0 to $455, and outpatient substance abuse services carry a copay of $15 for group sessions and up to $25 for individual sessions.
Partial Hospitalization See details
AARP Medicare Advantage Essentials from UHC KC-4 (PPO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by the AARP Medicare Advantage Essentials from UHC KC-4 (PPO) with a $290 copay and no coinsurance for both ground and air services, requiring prior authorization. Routine transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage Essentials from UHC KC-4 (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature a copay ranging from no copay to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are fully covered with no copay and no coinsurance.
Primary Care See details
Primary care benefits for the AARP Medicare Advantage Essentials from UHC KC-4 (PPO) feature no copay and no coinsurance for primary care provider visits and telehealth. Specialist visits range from a $0 to $35 copay with no coinsurance, while physical, occupational, and speech therapies require a $25 copay with no coinsurance. Chiropractic services have a $15 copay and no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by the AARP Medicare Advantage Essentials from UHC KC-4 (PPO) with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, glaucoma screenings, and a fitness benefit. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, alternative therapies, and counseling.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage Essentials from UHC KC-4 (PPO), which offers one annual routine hearing exam with no copay and no coinsurance, but does not cover hearing aid fittings or evaluations. Covered prescription hearing aids have a copay of $199 to $1,249 with no coinsurance, and OTC hearing aids have a copay of $199 to $829 with no coinsurance, though inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision Services are partially covered by AARP Medicare Advantage Essentials from UHC KC-4 (PPO), as other eye exam services, combined eyeglasses (lenses and frames), and upgrades are not covered. Routine eye exams are covered once per year with no copay and no coinsurance, while covered eyewear has no coinsurance and a $0 copay (except eyeglass lenses which have a $0 to $153 copay) up to a $150 combined maximum limit every two years.
Dental Services See details
Dental services are partially covered under the AARP Medicare Advantage Essentials from UHC KC-4 (PPO), which only covers Medicare-covered dental services with no copay and a 20% coinsurance, subject to prior authorization. Preventive and comprehensive dental care, including oral exams, cleanings, x-rays, fluoride treatments, restorative services, and implants, are not covered.
Home Infusion bundled Services See details
AARP Medicare Advantage Essentials from UHC KC-4 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
AARP Medicare Advantage Essentials from UHC KC-4 (PPO) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required for these services.
Medical Equipment See details
Medical equipment covered by AARP Medicare Advantage Essentials from UHC KC-4 (PPO) requires no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay from specified manufacturers, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the AARP Medicare Advantage Essentials from UHC KC-4 (PPO) plan, featuring a $50 copay and no coinsurance for diagnostic tests, and no copay or coinsurance for lab services. Outpatient X-rays require a $30 copay and coinsurance, while diagnostic radiological services have a $0 minimum copay and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are fully covered under the AARP Medicare Advantage Essentials from UHC KC-4 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and no coinsurance under the AARP Medicare Advantage Essentials from UHC KC-4 (PPO) plan, subject to prior authorization. Although some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage Essentials from UHC KC-4 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
AARP Medicare Advantage Essentials from UHC KC-4 (PPO) provides partial coverage for other services, which includes a chronic illness meal benefit with no copay and no coinsurance, though prior authorization is required. Acupuncture and Over-the-Counter (OTC) items are not covered under this benefit.
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