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UHC Medicare Advantage TX-0030 (Regional PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Medicare Advantage TX-0030 (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 TX-0030 (Regional PPO) in 2025, please refer to our full plan details page.
UHC Medicare Advantage TX-0030 (Regional PPO) is a Regional PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of Texas. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that UHC Medicare Advantage TX-0030 (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 TX-0030 (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 TX-0030 (Regional PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $64.00. 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 $7900.00 (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 $7900.00 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 TX-0030 (Regional PPO) plan has an enhanced alternative drug benefit. The plan has a $570 deductible. During the initial coverage phase, after you pay your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $14 copay for a preferred generic drug at a standard pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The UHC Medicare Advantage TX-0030 (Regional PPO) plan offers a range of benefits with varying costs. Hospital stays have a copay, while outpatient services have copays that vary by service. Primary care, preventive services, and home health services are available with no copay. This plan covers ambulance services, emergency services, and hearing and vision services, with some copays and coinsurance. Additionally, the plan offers coverage for medical equipment, diagnostic services, and skilled nursing facilities with specific cost-sharing structures. Dental services have 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $475 copay for days 1-5, and no copay for days 6-90, with no coinsurance. For Inpatient Hospital Psychiatric, you'll pay a $475 copay for days 1-4, and no copay for days 5-90, with no coinsurance. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, nor are Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered under the UHC Medicare Advantage TX-0030 (Regional PPO) plan. Outpatient Hospital Services have a copay between $0 and $475, and Observation Services have a copay of $475. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay between $0 and $25 for individual sessions, and a $15 copay for group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by UHC Medicare Advantage TX-0030 (Regional PPO), with no coinsurance. Medicare-covered ground and air ambulance services have a $290 copay, while 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 under the UHC Medicare Advantage TX-0030 (Regional PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The UHC Medicare Advantage TX-0030 (Regional PPO) plan covers primary care physician services with a copay between $0 and $15, chiropractic services with a $15 copay, occupational therapy services with a copay between $0 and $35, physician specialist services with a copay between $0 and $55, mental health specialty services with a copay between $0 and $25 for individual sessions and $15 for group sessions, podiatry services with a $45 copay, other health care professional services with a copay between $0 and $55, psychiatric services with a copay between $0 and $25 for individual sessions and $15 for group sessions, physical therapy and speech-language pathology services with a copay between $0 and $50, additional telehealth benefits with no copay, and opioid treatment program services with no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for an annual physical exam with no copay, and other preventive services including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. Additional preventive services such as health education, in-home safety assessment, and others are not covered.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are covered for one visit per year. Prescription hearing aids are partially covered, with copays ranging from $199 to $1249 for all types of hearing aids, but not for inner, outer, or over-the-ear hearing aids. OTC hearing aids are covered with a copay of $99 to $829 per year for a maximum of 2.
Vision Services See details
Vision Services include routine eye exams with no copay, and are covered once per year. Eyewear benefits are also covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered by the UHC Medicare Advantage TX-0030 (Regional PPO) plan, with a 20% coinsurance for Medicare Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, 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, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the UHC Medicare Advantage TX-0030 (Regional PPO) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment is covered by the UHC Medicare Advantage TX-0030 (Regional PPO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment including Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and radiological services, are covered. Diagnostic Procedures/Tests have a $50 copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of up to $250, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by UHC Medicare Advantage TX-0030 (Regional PPO) 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 under the UHC Medicare Advantage TX-0030 (Regional PPO) plan, but the plan does not cover the sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will pay no copay for days 1-20, and a $203 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the UHC Medicare Advantage TX-0030 (Regional PPO) plan, including acupuncture, over-the-counter items, meal benefits, and more. This plan does not require authorization or a referral for additional services.
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