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AARP Medicare Advantage from UHC OH-0016 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AARP Medicare Advantage from UHC OH-0016 (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 OH-0016 (PPO) in 2026, please refer to our full plan details page.
AARP Medicare Advantage from UHC OH-0016 (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2026 to people living in Select Counties in Ohio. 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 OH-0016 (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 OH-0016 (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 OH-0016 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. 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 $520.00 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 $10100.00 (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 $10100.00 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 OH-0016 (PPO) plan features an annual prescription drug deductible of $520. Tier 1 preferred generic drugs have no copay for standard pharmacy options and three-month mail orders. Tier 2 generic drugs cost a $12 copay for a one-month supply at standard pharmacies, though you can save with no copay on a three-month supply through preferred mail order. For brand-name and specialty medications, costs are determined by coinsurance percentages rather than flat copays. Tier 3 preferred brand drugs require a 16% coinsurance, while Tier 4 non-preferred drugs carry a 43% coinsurance for a one-month supply. Tier 5 specialty drugs require a 27% coinsurance for a one-month supply across standard pharmacies and mail-order services.
Additional Benefits
The AARP Medicare Advantage from UHC OH-0016 (PPO) plan offers comprehensive coverage for essential medical services, featuring no copays or coinsurance for primary care and telehealth visits. Specialized care, outpatient services, and emergency room visits generally require flat copayments with no coinsurance, such as a $130 copay for emergency care and a $0 to $50 copay for specialists. Inpatient hospital stays require a $425 daily copay for the first five to six days, after which there is no copay, while skilled nursing facility stays feature no copay for the first 20 days. Routine preventive services, including annual physicals, preventive dental cleanings, and vision and hearing screenings, are covered with no copays or coinsurance. For advanced healthcare needs, the plan provides partial coverage for hearing aids and eyewear with set copayments, while dialysis and durable medical equipment require a 20% coinsurance with no copay. Diagnostic lab work, home health visits, and cardiac rehabilitation services are also available with no copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by AARP Medicare Advantage from UHC OH-0016 (PPO) with no coinsurance, requiring a $425 copay for days 1–6 of acute stays and days 1–5 of psychiatric stays, and no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
AARP Medicare Advantage from UHC OH-0016 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital and observation services require a copay ranging from $0 to $425, while outpatient substance abuse services have a copay of $0 to $25 for individual sessions and $15 for group sessions.
Partial Hospitalization See details
AARP Medicare Advantage from UHC OH-0016 (PPO) covers partial hospitalization with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance services under the AARP Medicare Advantage from UHC OH-0016 (PPO) plan are covered with a $275 copay for both ground and air transportation and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
AARP Medicare Advantage from UHC OH-0016 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services feature a copay ranging from $0 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 services are covered by the AARP Medicare Advantage from UHC OH-0016 (PPO) plan with no copay and no coinsurance for primary care doctor and telehealth visits. Specialist visits, mental health sessions, and physical therapies 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 partially covered by AARP Medicare Advantage from UHC OH-0016 (PPO) with no copay and no coinsurance for covered options such as annual physicals, fitness benefits, and select screenings. Uncovered services include 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, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by AARP Medicare Advantage from UHC OH-0016 (PPO), offering one routine hearing exam annually with no copay and no coinsurance, though fitting and evaluation exams are not covered. Up to two prescription hearing aids (with a $199.00 to $1,249.00 copay and no coinsurance) and two OTC hearing aids (with a $199.00 to $829.00 copay and no coinsurance) are covered each year, though inner ear, outer ear, and over-the-ear prescription models are excluded.
Vision Services See details
Vision Services from AARP Medicare Advantage from UHC OH-0016 (PPO) are partially covered, featuring one routine eye exam annually with no deductible, no copay, and no coinsurance. Covered eyewear, such as contacts, frames, and lenses, has no deductible or coinsurance and copays ranging from $0 to $153 up to a $300 combined limit every two years, though upgrades and other eye exam services are not covered.
Dental Services See details
Dental Services are partially covered by AARP Medicare Advantage from UHC OH-0016 (PPO), offering preventive care like exams, cleanings, and x-rays with no copay and no coinsurance, while Medicare-covered dental services require no copay and a 20% coinsurance. Several major services are not covered under this plan, including restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the AARP Medicare Advantage from UHC OH-0016 (PPO) with no copay, although prior authorization is required. Associated Medicare Part B drugs, such as chemotherapy and insulin, require no coinsurance to 20% coinsurance, with insulin also having a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the AARP Medicare Advantage from UHC OH-0016 (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
AARP Medicare Advantage from UHC OH-0016 (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by AARP Medicare Advantage from UHC OH-0016 (PPO), with prior authorization required. Lab services and diagnostic radiology require no copay and no coinsurance, while diagnostic tests have a $55 copay and outpatient X-rays have a $15 copay. Therapeutic radiological services are subject to a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the AARP Medicare Advantage from UHC OH-0016 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by AARP Medicare Advantage from UHC OH-0016 (PPO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
AARP Medicare Advantage from UHC OH-0016 (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance and does not require a prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the standard Medicare limit are not covered.
Other Services See details
AARP Medicare Advantage from UHC OH-0016 (PPO) partially covers other services, offering a chronic illness meal benefit with no copay, no coinsurance, and prior authorization required. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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