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UHC Medicare Advantage NY-0021 (Regional PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Medicare Advantage NY-0021 (Regional PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Medicare Advantage NY-0021 (Regional PPO) in 2025, please refer to our full plan details page.
UHC Medicare Advantage NY-0021 (Regional PPO) is a Regional PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of New York. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that UHC Medicare Advantage NY-0021 (Regional 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 UHC Medicare Advantage NY-0021 (Regional 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 UHC Medicare Advantage NY-0021 (Regional PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $75.00. 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 UHC Medicare Advantage NY-0021 (Regional PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a deductible of $570. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. For example, for a standard pharmacy, you will pay a $14 copay for preferred generic drugs, a $47 copay for standard generic drugs, and a $100 copay for preferred brand drugs. Non-preferred drugs have a 26% coinsurance. After your total yearly drug costs reach $2000, you pay nothing for covered Part D drugs.
Additional Benefits
The UHC Medicare Advantage NY-0021 (Regional PPO) plan offers comprehensive coverage with a variety of benefits. This plan covers inpatient hospital stays with a copay, and outpatient services including primary care, specialist visits, and mental health services, often with no copay. Additional benefits include preventive services, hearing and vision care, and dental services, with varying copays or coinsurance depending on the specific service.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $425 copay for days 1-5, and no copay for days 6-90, with no coinsurance; additional days 91-999 have no copay. Inpatient Hospital Psychiatric has a $425 copay for days 1-4, and no copay for days 5-90, with no coinsurance. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered under the UHC Medicare Advantage NY-0021 (Regional PPO) plan. Outpatient hospital services have a copay between $0 and $425, observation services have a $425 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse services have a copay, with individual sessions ranging from $0 to $25 and group sessions at $15. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services for UHC Medicare Advantage NY-0021 (Regional PPO) includes coverage for both ground and air ambulance services, each with a $290 copay, and 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. Emergency Services have a $110 copay, and Urgently Needed Services have a copay between $0 and $45; both have no coinsurance. Worldwide Emergency Services has no coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The UHC Medicare Advantage NY-0021 (Regional PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a copay between $0 and $25. The plan also covers physician specialist services with a copay between $0 and $40, mental health specialty services with a copay between $0 and $25 for individual sessions and $15 for group sessions, and podiatry services with a $30 copay. Other covered services include other health care professional services with a copay between $0 and $40, psychiatric services with a copay between $0 and $25 for individual sessions and $15 for group sessions, and physical therapy and speech-language pathology services with a copay between $0 and $25. Additional telehealth benefits have no copay, and opioid treatment program services have no copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and Fitness Benefit with no copay, while other services like Health Education and counseling services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with no copay, while routine hearing exams are limited to 1 per year with no copay. Prescription hearing aids are covered with a copay between $199 and $1249 for all types, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids have a copay between $99 and $829, with a limit of 2 per year.
Vision Services See details
Vision services include routine eye exams and eyewear, with no copay for routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $200 per year for both in and out-of-network services. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other services like Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services with no copay. 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, 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%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Medicare Advantage NY-0021 (Regional PPO) plan. The plan requires prior authorization, and you will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies - Non-Medicare benefit with 20% coinsurance. 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 diagnostic procedures and tests with a copay of $50, lab services with no copay, and diagnostic radiological services with a copay of up to $240. Therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have a copay of $35.
Home Health Services See details
Home Health Services are covered by the UHC Medicare Advantage NY-0021 (Regional 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 specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UHC Medicare Advantage NY-0021 (Regional PPO), but require prior authorization. There is no copay for days 1-20, and a $203 copay for days 21-100; there is no coinsurance. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services for the UHC Medicare Advantage NY-0021 (Regional PPO) plan includes a meal benefit with no copay and no coinsurance, but requires prior authorization, while acupuncture, over-the-counter items, 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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