AARP Medicare Advantage from UHC EP-4 (PPO)

4 out of 5 stars
$66.00
Monthly Premium

AARP Medicare Advantage from UHC EP-4 (PPO) is a PPO plan offered by UnitedHealthcare

Plan ID: H2406-135

HelpAdvisor Editorial Team analysis of data from the 2027 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.


Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.

Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.

Learn more about Medicare Advantage plans such as AARP Medicare Advantage from UHC EP-4 (PPO) - H2406-135 by UnitedHealthcare as well as other Medicare Advantage plans available in your area.

$66.00
Monthly Premium

New Mexico Counties Served

Basic Costs and Coverage

Coverage Cost
Drug Deductible $440
Out of Pocket Max In-Network: $4200
Out-of-Network: N/A
Initial Coverage Limit $0
Catastrophic Coverage Limit $2100
Primary Care Doctor Visit
Out-of-Network:

Doctor Office Visit Services:
Copayment for Medicare Covered Primary Care Office Visit $25
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $0 to $45
Prior Authorization Required for Doctor Specialty Visit
Note: The lower cost share applies to Medicare covered telehealth and Medicare covered remote monitoring. The higher cost share applies to all other Medicare covered services.
Inpatient Hospital Care
Out-of-Network:

Acute Hospital Services:
$595 per day for days 1 to 11
$0 per day for days 12 to 999
Note: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b.
Urgent Care
Urgent Care:
Copayment for Urgent Care $0 to $65

Note: The lower cost share applies to Medicare covered telehealth. The higher cost share applies to all other Medicare covered services.
Emergency Room Visit
Emergency Care:
Copayment for Emergency Care $150
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours
Ambulance Transportation
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $240

Air Ambulance:
Copayment for Air Ambulance Services $240
Prior Authorization Required for Air Ambulance

Health Care Services and Medical Supplies

AARP Medicare Advantage from UHC EP-4 (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $20
Prior Authorization Required for Chiropractic Services

Out-of-Network:

Chiropractic Services:
Copayment for Medicare Covered Chiropractic Services $90
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:

Diabetic Supplies and Services:
Copayment for Medicare-covered Diabetic Supplies $0
Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20%
Durable Medical Equipment (DME)
Out-of-Network:

Durable Medical Equipment Services:
Coinsurance for Medicare Covered Durable Medical Equipment 50%
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Out-of-Network:

Diagnostic Procedures/Tests Services:
Coinsurance for Medicare Covered Diagnostic Procedures/Tests 40%
Copayment for Medicare Covered Lab Services $0
Coinsurance for Medicare Covered Diagnostic Radiological Services 40%
Coinsurance for Medicare Covered Therapeutic Radiological Services 40%
Copayment for Medicare Covered Outpatient X-Ray Services $15
Home Health Care
Out-of-Network:

Home Health Services:
Coinsurance for Medicare Covered Home Health 50%
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$345 per day for days 1 to 6
$0 per day for days 7 to 90
Prior Authorization Required for Psychiatric Hospital Services
Benefit Details - General Note - NOTE ON INPATIENT SUBSTANCE ABUSE: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b.
Mental Health Outpatient Care
Out-of-Network:

Mental Health Services:
Copayment for Medicare Covered Individual Sessions $40
Copayment for Medicare Covered Group Sessions $30
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0 to $345
Prior Authorization Required for Outpatient Hospital Services
Note: The lower cost share applies to outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures.Note: Benefit category includes both the facility and professional component.

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per day $345
Prior Authorization Required for Outpatient Observation Services
Benefit Details - General 9a2 Note - NOTE ON OBSERVATION SERVICES: Benefit category includes both the facility and professional component.

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0 to $295
Prior Authorization Required for Ambulatory Surgical Center Services
Benefit Details - General 9b Note - NOTE ON ASC SERVICES: Benefit category 9b includes both the facility and professional component.Benefit Details - General 9b Note - NOTE ON COST SHARING RANGE FOR ASC Services: The lower cost share applies to outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures.
Outpatient Substance Abuse Care
Out-of-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual Sessions $40
Copayment for Medicare Covered Group Sessions $30
Note: The lower cost share applies to Medicare covered telehealth for individual sessions. The higher cost share applies to all other Medicare covered services.
In-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $0 to $25
Copayment for Medicare-covered Group Sessions $15
Prior Authorization Required for Outpatient Substance Abuse Services
Note: The lower cost share applies to Medicare covered telehealth for individual sessions. The higher cost share applies to all other Medicare covered services.
Over-the-counter (OTC) Items
Out-of-Network:

Over-The-Counter (OTC) Items Services:
Coinsurance for Non-Medicare Covered Over-The-Counter (OTC) Items 90%
Podiatry Services
In-Network
$45 copay 6 visits per year
Out-of-Network:

Podiatry Services:
Copayment for Medicare Covered Podiatry Services $90
Skilled Nursing Facility Care
Out-of-Network:

Skilled Nursing Facility Services:
$250 per day for days 1 to 100

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
$3,000 allowance per year toward covered preventive and comprehensive services.
$0 copay for covered preventive services such as oral exams, routine cleanings, X-rays and fluoride
50% of the cost for all covered comprehensive services, such as fillings, crowns, root canals, extractions, bridges and dentures
You will have access to one of Medicare Advantage's largest dental networks, or you can choose any dentist.

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network

Routine Eye Exam: $0 copay 1 exam per year
Routine Eyewear: $0 copay for standard prescription lenses
$200 allowance every 2 years for 1 pair of lenses/frames or contacts.

Out-of-Network: Routine Eye Exam:$90 copayRoutine Eyewear: 90% coinsurance up to allowance

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network

Routine Hearing Exam: $0 copay 1 exam per year
Routine Hearing Aids: $700 allowance up to 2 hearing aids per year
Choose from a broad selection of brand-name prescription hearing aids through UnitedHealthcare Hearing. Access to one of the largest national networks with thousands of hearing professionals.
Out-of-Network Routine Hearing Exam:$90 copay
Routine Hearing Aids:90% coinsurance up to allowance

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
Tobacco use cessation
Yearly "Wellness" visit

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