AARP Medicare Advantage from UHC GA-0006 (HMO-POS)
AARP Medicare Advantage from UHC GA-0006 (HMO-POS) H5322-042 Plan Details
AARP Medicare Advantage from UHC GA-0006 (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H5322-042
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Talk to a licensed agent today to find a plan that fits your needs.
$39.00
Monthly Premium
AARP Medicare Advantage from UHC GA-0006 (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H5322-042
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
AARP Medicare Advantage from UHC GA-0006 (HMO-POS) H5322-042 Plan Details
AARP Medicare Advantage from UHC GA-0006 (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H5322-042
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
$39.00
Monthly Premium
Georgia Counties Served
Baldwin
Peach
Spalding
Baker
Houston
Butts
Upson
Schley
Taylor
Worth
Jasper
Wilkes
Glascock
Laurens
Jones
Warren
Jefferson
Pike
Monroe
Twiggs
Hancock
Taliaferro
Sumter
Lamar
Washington
Bibb
Macon
Wilkinson
Terrell
Lee
Crawford
Russell
Gwinnett
Clayton
Barrow
Chatham
Cobb
Bartow
Rockdale
Henry
Gordon
Fulton
Hall
Dekalb
Oconee
Turner
Tattnall
Candler
Dodge
Clinch
Berrien
Clarke
Johnson
Elbert
Muscogee
Ben Hill
Towns
Echols
Oglethorpe
Polk
Effingham
Chattahoochee
Franklin
Miller
Thomas
Screven
Tift
Whitfield
Mcduffie
Cook
Pierce
Brantley
Dooly
Seminole
Rabun
Meriwether
Evans
Coffee
Calhoun
Emanuel
Lanier
Bleckley
Clay
Floyd
Richmond
Stewart
Murray
Long
Charlton
Union
Marion
Jenkins
Greene
Grady
Glynn
Colquitt
Toombs
Quitman
Crisp
Ware
Stephens
Pickens
Wayne
Montgomery
Putnam
Madison
Habersham
Heard
Harris
Atkinson
Bryan
Jackson
Mcintosh
Dade
Gadsden
Fannin
Walton
Banks
Burke
Lowndes
Talbot
Appling
Catoosa
Decatur
Morgan
Newton
Lincoln
Haralson
Columbia
Mitchell
Bacon
Pulaski
Webster
Wilcox
Telfair
Walker
Hart
Liberty
Dawson
Chattooga
Randolph
Gilmer
Troup
Early
Irwin
Lumpkin
White
Treutlen
Brooks
Wheeler
Jeff Davis
Coweta
Paulding
Bulloch
Douglas
Cherokee
Forsyth
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $4900 Out-of-Network: 9550 |
| Initial Coverage Limit | $5030 |
| Catastrophic Coverage Limit | $8,000 |
| Primary Care Doctor Visit | In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0.00 |
| Specialty Doctor Visit | In-Network: Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $0.00 to $30.00 Prior Authorization Required for Doctor Specialty Visit Prior authorization required |
| Inpatient Hospital Care | In-Network: Acute Hospital Services: $265.00 per day for days 1 to 5 $0.00 per day for days 6 to 90 Prior Authorization Required for Acute Hospital Services Prior authorization required |
| Urgent Care | Copayment for Urgent Care $0.00 to $40.00 Benefit Details - General 4b Note - NOTE ON COST SHARING RANGE FOR URGENTLY NEEDED SERVICES: $0 copayment applies to Medicare covered telehealth. The higher cost share applies to all other Medicare covered services. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0.00 |
| Emergency Room Visit | Copayment for Emergency Care $120.00 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $0.00 Copayment for Worldwide Emergency Transportation $0.00 |
| Ambulance Transportation | In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $290.00 Air Ambulance: Copayment for Air Ambulance Services $290.00 Benefit Details - General 10a Note - NOTE ON AUTHORIZATION: Authorization is required for Non-emergency Medicare-covered ambulance ground and air transportation. Emergency Ambulance does not require authorization. Please see Evidence of Coverage for Prior Authorization rules Prior authorization required POS (Out-of-Network): Ambulance Services: Copayment for Medicare Covered Ambulance Services - Ground $290.00 Copayment for Medicare Covered Ambulance Services - Air $290.00 |
Health Care Services and Medical Supplies
AARP Medicare Advantage from UHC GA-0006 (HMO-POS) 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: Copayment for Medicare-covered Chiropractic Services $15.00 Prior Authorization Required for Chiropractic Services Prior authorization required |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Copayment for Medicare-covered Diabetic Supplies $0.00 Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20% Prior Authorization Required for Diabetic Supplies and Services Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage) Prior authorization required |
| Durable Medical Eqipment (DME) | In-Network: Coinsurance for Medicare-covered Durable Medical Equipment 20% Prior Authorization Required for Durable Medical Equipment Prior authorization required |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $45.00 Copayment for Medicare-covered Lab Services $0.00 Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0.00 to $155.00 Copayment for Medicare-covered Therapeutic Radiological Services $60.00 Copayment for Medicare-covered X-Ray Services $15.00 Prior Authorization Required for Outpatient Diag/Therapeutic Rad Services Prior authorization required |
| Home Health Care | In-Network: Copayment for Medicare-covered Home Health Services $0.00 Prior Authorization Required for Home Health Services Prior authorization required |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: $265.00 per day for days 1 to 5 $0.00 per day for days 6 to 90 Prior Authorization Required for Psychiatric Hospital Services Prior authorization required Out-of-Network: Coinsurance for Psychiatric Hospital Services per Stay 40% |
| Mental Health Outpatient Care | In-Network: Copayment for Medicare-covered Individual Sessions $0.00 to $25.00 Copayment for Medicare-covered Group Sessions $15.00 Prior Authorization Required for Outpatient Mental Health Services Prior authorization required POS (Out-of-Network): Coinsurance for Medicare Covered Individual Sessions 40% Coinsurance for Medicare Covered Group Sessions 40% |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0.00 to $265.00 Prior Authorization Required for Outpatient Hospital Services Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per day $265.00 Prior Authorization Required for Outpatient Observation Services Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0.00 to $210.00 Prior Authorization Required for Ambulatory Surgical Center Services Prior authorization required |
| Outpatient Substance Abuse Care | In-Network: Copayment for Medicare-covered Individual Sessions $0.00 to $25.00 Copayment for Medicare-covered Group Sessions $15.00 Prior Authorization Required for Outpatient Substance Abuse Services Prior authorization required POS (Out-of-Network): Coinsurance for Medicare Covered Individual or Group Sessions 40% |
| Over-the-counter (OTC) Items | In-Network: Over-The-Counter (OTC) Items: Copayment for Over-The-Counter (OTC) Items $0.00 Maximum Plan Benefit of $50.00 every three months Nicotine Replacement Therapy (NRT) offerred as a Part C OTC benefit |
| Podiatry Services | In-Network: Copayment for Medicare-Covered Podiatry Services $30.00 Copayment for Routine Foot Care $30.00
Prior authorization required |
| Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: $0.00 per day for days 1 to 20 $203.00 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services Prior authorization required |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network: Preventive Dental: Copayment for Oral Exams $0.00
Comprehensive Dental: Coinsurance for Medicare-covered Benefits 20% Copayment for Non-routine Services $0.00 Copayment for Diagnostic Services $0.00
Prior Authorization Required for Comprehensive Dental Prior authorization required POS (Out-of-Network): Non-Medicare Covered Dental Services: Copayment for Non-Medicare Covered Preventive Dental $0.00 Coinsurance for Non-Medicare Covered Comprehensive Dental 0% to 50% |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network: Eye Exams: Copayment for Medicare Covered Benefits $0.00 Copayment for Routine Eye Exams $0.00
Eyewear: Copayment for Medicare-Covered Benefits $0.00 Copayment for Contact Lenses $0.00 Copayment for Eyeglasses (lenses and frames) $0.00
Prior authorization required |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $0.00 Copayment for Routine Hearing Exams $0.00
Hearing Aids: Copayment for Hearing Aids $99.00 to $1249.00
Prior authorization required |
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:
Yearly "Wellness" visit |
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