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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 2025, 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 out of 5 stars in 2025.
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 $47.00. 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 $570.00 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-0005 (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $570.00. After you meet your deductible, your costs will vary depending on the drug tier and pharmacy you use. For example, you will pay a $12.00 copay for preferred generic drugs at a standard pharmacy. However, you will pay 26% coinsurance for non-preferred drugs.
Additional Benefits
The AARP Medicare Advantage from UHC NJ-0005 (PPO) plan offers a range of benefits, including no copays for primary care visits, preventive services, home health services, and hearing exams. Hospital stays have a copay for the first few days, and emergency services have a copay. This plan provides coverage for outpatient services, vision, and dental care, with varying copays or coinsurance depending on the service. It also includes benefits like ambulance services, medical equipment, and some diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For the first 4 days, there is a $395 copay, and for days 5-90, there is no copay.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $395, observation services have a $395 copay, ambulatory surgical center services have no copay, individual substance abuse sessions have a copay between $0 and $25, group substance abuse sessions have a $15 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by AARP Medicare Advantage from UHC NJ-0005 (PPO). Ground and air ambulance services each have a $275 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the AARP Medicare Advantage from UHC NJ-0005 (PPO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The AARP Medicare Advantage from UHC NJ-0005 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a copay between $0-$10, physician specialist services with a copay between $0-$10, and mental health specialty services with a copay between $0-$25 for individual sessions and $15 for group sessions. Podiatry services and other health care professional services have a copay between $10-$10, psychiatric services have a copay between $0-$25 for individual sessions and $15 for group sessions, physical therapy and speech-language pathology services have a copay between $0-$10, additional telehealth benefits have no copay, and opioid treatment program services have no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include no copay for annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Other preventive services are covered, and the Fitness Benefit offers no copay, as do Home and Bathroom Safety Devices and Modifications. However, Health Education, In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, 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 Benefits, 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, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with no copay, while routine hearing exams are limited to one per year. Prescription hearing aids are covered with a copay between $199 and $1249, and OTC hearing aids have a copay between $99 and $829, with a limit of two per year. Fitting/Evaluation for Hearing Aid, and Prescription Hearing Aids - Inner Ear, - Outer Ear, and - Over the Ear are not covered.
Vision Services See details
The AARP Medicare Advantage from UHC NJ-0005 (PPO) plan covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum of $250.00 every two years. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a 20% coinsurance. Other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, are covered with no copay. Restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no copay. Prosthodontics (removable and fixed) have a coinsurance of 0% to 50%. Implant services and orthodontics 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%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the AARP Medicare Advantage from UHC NJ-0005 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, including Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a $50 copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $250, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $40 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the AARP Medicare Advantage from UHC NJ-0005 (PPO) plan 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 the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and copays may apply.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AARP Medicare Advantage from UHC NJ-0005 (PPO) with prior authorization required. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The AARP Medicare Advantage from UHC NJ-0005 (PPO) plan covers Over-the-Counter (OTC) items and Meal Benefits with no copay. 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.
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