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UnitedHealthcare

Plan ID: H2406-16-0

AARP Medicare Advantage from UHC FL-0024 (PPO)

2024 AARP Medicare Advantage from UHC FL-0024 (PPO) H2406 — 016 — 0 is a Medicare Advantage plan with drug coverage. It has received a 4-out-of-5 star rating from CMS for 2024.

Learn more about AARP Medicare Advantage from UHC FL-0024 (PPO) H2406 - 016 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.

4 / 5 stars for 2024

$0.00 /mo

Monthly premium

Health deductible

Drug deductible

$4900.00

Out-of-pocket maximum

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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week!

Overview Benefits & Costs Drug Coverage Additional Benefits

Plan Overview

2024 AARP Medicare Advantage from UHC FL-0024 (PPO) H2406 — 016 — 0 is a Local PPO offered in Lake, Marion, and Sumter Counties by UnitedHealthcare. It has a monthly premium of $0.00.

Premium Breakdown

Standard Part B Premium

$174.70

Part B premium reduction

- $0

Monthly Plan Premium

$0.00

Total Premium:

$174.70

Note:

The standard Part B premium for 2024 is $174.70. Your Part B premium may differ based on factors including late enrollment, income, and disability status. Higher-income beneficiaries may pay an income-related monthly adjustment amount (IRMAA). The Part B premium is required to be paid by everyone enrolled in Medicare Part B.

Special needs plan type

Out-of-pocket maximum

$4900.00

Plan Organization:

UnitedHealthcare

Plan Type:

Local PPO

Location:

Lake, Marion, and Sumter Counties

Drugs Covered:

Yes

Drug Formulary:

Formulary Link

Pharmacies:

Pharmacies Link

Doctor Choice:

Any Doctor

Doctors Link:

Doctors Link

Deductibles

The amount you must pay each year before your plan starts to pay for covered services or drugs.

Health deductible

Drug deductible

Sign up for AARP Medicare Advantage from UHC FL-0024 (PPO)

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Drug Coverage

AARP Medicare Advantage from UHC FL-0024 (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Benefit Type

Enhanced

Prescription drug deductible

Increased initial coverage limit

Additional gap coverage

Yes

Part D Premium Reduction

This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.

Part D	LIS 25%	LIS 50%	LIS 75%	LIS Full
$0.00	$0.00	$0.00	$0.00	$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.

30 Days

60 Days

90 Days

Tier	Preferred Pharmacy	Standard Pharmacy	Preferred Mail	Standard Mail
1. Preferred Generic	-	$0.00 copay	-	-
2. Standard Generic	-	$10.00 copay	-	-
3. Preferred Brand	-	$45.00 copay	-	-
4. Non-Preferred Drug	-	$95.00 copay	-	-
5. Specialty Tier	-	33%	33%	33%

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.

30 Days

60 Days

90 Days

Tier	Preffered Pharmacy	Standard Pharmacy	Preffered Mail	Standard Mail
Preferred Generic	-	$0.00 copay	-	-
Generic	-	$10.00 copay	-	-

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

Generic Drugs

$4.15 copay or 5% (whichever costs more)

Brand-name

$10.35 copay or 5% (whichever costs more)

Additional Benefits

AARP Medicare Advantage from UHC FL-0024 (PPO) also provides the following benefits.

Note:

Limits, Authorizations, and Referrals may apply for the benefits below. Contact the plan for details.

Comprehensive dental

Non-routine services

In-Network: $0 copay

Out-Of-Network: 0-50% coinsurance

Diagnostic services

In-Network: $0 copay

Out-Of-Network: 0-50% coinsurance

Restorative services

In-Network: $0 copay

Out-Of-Network: 0-50% coinsurance

Endodontics

In-Network: $0 copay

Out-Of-Network: 0-50% coinsurance

Periodontics

In-Network: $0 copay

Out-Of-Network: 0-50% coinsurance

Extractions

In-Network: $0 copay

Out-Of-Network: 0-50% coinsurance

Prosthodontics, other oral/maxillofacial surgery, other services

In-Network: 0-50% coinsurance

Out-Of-Network: 0-50% coinsurance

Preventive dental

Oral exam

In-Network: $0 copay

Out-Of-Network: $0 copay

Cleaning

In-Network: $0 copay

Out-Of-Network: $0 copay

Fluoride treatment

In-Network: $0 copay

Out-Of-Network: $0 copay

Dental x-ray(s)

In-Network: $0 copay

Out-Of-Network: $0 copay

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures

In-Network: $45 copay

Out-Of-Network: 40% coinsurance

Lab services

In-Network: $0 copay

Out-Of-Network: $0 copay

Diagnostic radiology services (eg, MRI)

In-Network: $0-190 copay

Out-Of-Network: 40% coinsurance

Outpatient x-rays

In-Network: $15 copay

Out-Of-Network: $30 copay

Doctor visits

Primary

In-Network: $0 copay

Out-Of-Network: $45 copay per visit

Specialist

In-Network: $0-35 copay per visit

Out-Of-Network: $70 copay per visit

Emergency care/Urgent care

Emergency

$120 copay per visit (always covered)

Urgent care

$0-40 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment

In-Network: $35 copay

Out-Of-Network: $70 copay

Routine foot care

In-Network: $35 copay

Ground ambulance

Service

In-Network: $290 copay

Out-Of-Network: $290 copay

Hearing

Hearing exam

In-Network: $0 copay

Out-Of-Network: $70 copay

Fitting/evaluation

Not covered

Hearing aids

In-Network: $99-1,249 copay

Out-Of-Network: $99-1,249 copay

Inpatient hospital coverage

Service

In-Network: $275 per day for days 1 through 4 $0 per day for days 5 through 90 $0 per day for days 91 and beyond

Out-Of-Network: 40% per stay

Outpatient hospital coverage

Service

In-Network: $0-275 copay per visit

Out-Of-Network: 40% coinsurance per visit

Optional benefits

Service

Medical equipment/supplies

Durable medical equipment (eg, wheelchairs, oxygen)

In-Network: 20% coinsurance per item

Out-Of-Network: 50% coinsurance per item

Prosthetics (eg, braces, artificial limbs)

In-Network: 20% coinsurance per item

Out-Of-Network: 50% coinsurance per item

Diabetes supplies

In-Network: $0 copay per item

Out-Of-Network: 50% coinsurance per item

Medicare Part B drugs

Chemotherapy

In-Network: 0-20% coinsurance

Out-Of-Network: 0-50% coinsurance

Other Part B drugs

In-Network: 0-20% coinsurance

Out-Of-Network: 0-50% coinsurance

Part B Insulin drugs

In-Network: 0-20% coinsurance (up to $35)

Out-Of-Network: 0-50% coinsurance

Mental health services

Inpatient hospital - psychiatric

In-Network: $275 per day for days 1 through 4 $0 per day for days 5 through 90

Out-Of-Network: 40% per stay

Outpatient group therapy visit with a psychiatrist

In-Network: $15 copay

Out-Of-Network: $30-40 copay

Outpatient individual therapy visit with a psychiatrist

In-Network: $0-25 copay

Out-Of-Network: $30-40 copay

Outpatient group therapy visit

In-Network: $15 copay

Out-Of-Network: $30-40 copay

Outpatient individual therapy visit

In-Network: $0-25 copay

Out-Of-Network: $30-40 copay

Preventive care

Service

In-Network: $0 copay

Out-Of-Network: 0-40% coinsurance

Rehabilitation services

Occupational therapy visit

In-Network: $0-25 copay

Out-Of-Network: $70 copay

Physical therapy and speech and language therapy visit

In-Network: $0-25 copay

Out-Of-Network: $70 copay

Skilled Nursing Facility

Service

In-Network: $0 per day for days 1 through 20 $203 per day for days 21 through 100

Out-Of-Network: $225 per day for days 1 through 40 $0 per day for days 41 through 100

Transportation

Service

Not covered

Vision

Routine eye exam

In-Network: $0 copay

Out-Of-Network: $70 copay

Other

Not covered

Contact lenses

In-Network: $0 copay

Out-Of-Network: $0 copay

Eyeglasses (frames and lenses)

In-Network: $0 copay

Out-Of-Network: $0 copay

Eyeglass frames

Not covered

Eyeglass lenses

Not covered

Upgrades

Not covered

Wellness programs (eg, fitness, nursing hotline)

Service

Covered

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week

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Every year, Medicare evaluates plans based on a 5-star rating system.

Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.

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