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AARP Medicare Advantage from UHC NJ-0005 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC NJ-0005 (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-0005 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC NJ-0005 (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-0005 (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-0005 (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-0005 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.00. 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-0005 (PPO) prescription drug plan features an annual drug deductible of $600. For Tier 1 preferred generic drugs, members pay no copay for 1-month and 3-month fills at standard pharmacies or through mail order. Tier 2 generic drugs cost a $12 copay for a 1-month supply at standard pharmacies, but members can save with no copay for a 3-month supply when using preferred mail order. For higher-tier medications, cost sharing transitions to a percentage of the drug cost. Tier 3 preferred brand drugs require a 15% coinsurance for both 1-month and 3-month supplies. Tier 4 non-preferred drugs carry a 34% coinsurance, while Tier 5 specialty drugs require a 26% coinsurance for a 1-month supply.
Additional Benefits
The AARP Medicare Advantage from UHC NJ-0005 (PPO) plan offers robust coverage with no copay and no coinsurance for primary care visits, telehealth, annual physical exams, and home health services. Specialist visits range from no copay to a $30 copay, while inpatient hospital stays require a $445 daily copay for the first few days with no copay thereafter. Outpatient hospital services feature no coinsurance and copays ranging from $0 to $445, ensuring affordable access to essential medical care. This plan also includes valuable everyday benefits like dental, vision, and hearing care, featuring no copay for routine eye exams, preventive dental services, and routine hearing tests. Emergency room visits carry a $115 copay that is waived if admitted, while urgent care visits range from no copay to $40. Additionally, members can take advantage of no copay for over-the-counter items and home infusion services, though certain specialized services like dialysis and durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
AARP Medicare Advantage from UHC NJ-0005 (PPO) partially covers inpatient hospital care with no coinsurance, though prior authorization is required. Acute stays require a $445 copay per day for days 1 to 5 (no copay for days 6 and beyond) and psychiatric stays require a $445 copay per day for days 1 to 4 (no copay for days 5 to 90), while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by the AARP Medicare Advantage from UHC NJ-0005 (PPO) feature no coinsurance, with no copay for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $445 copay, observation services require a $445 daily copay, and outpatient substance abuse sessions require a $0 to $25 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the AARP Medicare Advantage from UHC NJ-0005 (PPO) plan with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
AARP Medicare Advantage from UHC NJ-0005 (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required and the copay is not waived if admitted to the hospital. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by AARP Medicare Advantage from UHC NJ-0005 (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copays and no coinsurance.
Primary Care See details
AARP Medicare Advantage from UHC NJ-0005 (PPO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $30 copay with no coinsurance. Physical, occupational, and speech therapies have a $30 copay and no coinsurance, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive Services are covered by the AARP Medicare Advantage from UHC NJ-0005 (PPO) plan with no copay and no coinsurance for annual physical exams, kidney disease education, and screenings. Additional preventive services are partially covered, offering fitness benefits and home safety devices with no copay or coinsurance, though sub-services such as health education, in-home support, and weight management are not covered.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC NJ-0005 (PPO), with fitting and evaluation for hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, not covered. Covered routine hearing exams have no copay and no coinsurance, while prescription hearing aids require a copay of $199.00 to $1,249.00 and OTC hearing aids require a copay of $199.00 to $829.00, with no coinsurance for either option.
Vision Services See details
AARP Medicare Advantage from UHC NJ-0005 (PPO) provides partially covered vision services with no coinsurance, including no copay for annual routine eye exams and contact lenses. Eyeglass frames and lenses are covered with copays from $0 to $153 up to a combined $150 limit every two years, while other eye exams, upgrades, and combined eyeglasses are not covered.
Dental Services See details
Dental services are partially covered by AARP Medicare Advantage from UHC NJ-0005 (PPO), which excludes coverage for implant services and orthodontics. Preventive services are available with no copay and no coinsurance, while Medicare-covered dental services carry a 20% coinsurance and comprehensive services require a 50% coinsurance, both with no copay up to a $1,500 annual limit.
Home Infusion bundled Services See details
AARP Medicare Advantage from UHC NJ-0005 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by AARP Medicare Advantage from UHC NJ-0005 (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment benefits covered by AARP Medicare Advantage from UHC NJ-0005 (PPO) require prior authorization and feature no copay alongside a 20% coinsurance for durable medical equipment, prosthetic devices, and medical supplies. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the AARP Medicare Advantage from UHC NJ-0005 (PPO) plan, with prior authorization required. Lab services feature no copay and no coinsurance, diagnostic procedures have a $50 copay with no coinsurance, and outpatient X-rays require a $30 copay. Diagnostic radiology copays start at $0, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
AARP Medicare Advantage from UHC NJ-0005 (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and no coinsurance under the AARP Medicare Advantage from UHC NJ-0005 (PPO) plan, though only some services are covered in practice. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the AARP Medicare Advantage from UHC NJ-0005 (PPO) plan with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and the plan does not cover additional days beyond the Medicare-covered limit.
Other Services See details
AARP Medicare Advantage from UHC NJ-0005 (PPO) partially covers other services, offering over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture is not covered, and prior authorization is required for the meal benefit.
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