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UHC Medicare Advantage TC-0001 (PPO)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
$0.00
Monthly Premium
UHC Medicare Advantage TC-0001 (PPO) is a PPO plan offered by UnitedHealthcare
Plan ID: H2001-104
HelpAdvisor Editorial Team analysis of data from the 2025 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 UHC Medicare Advantage TC-0001 (PPO) - H2001-104 by UnitedHealthcare as well as other Medicare Advantage plans available in your area.
$0.00
Monthly Premium
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $440 |
| Out of Pocket Max |
In-Network: $6700 Out-of-Network: 10100 |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2100 |
| Primary Care Doctor Visit | Routine Annual Physical Exam: $0 copay$ 1 per year |
| Specialty Doctor Visit | $45 copay |
| Inpatient Hospital Care | In-Network: Acute Hospital Services: $395 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Acute Hospital Services 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 | $50 copay per visit ($0 copay when outside of the United States) |
| Emergency Room Visit | Emergency Care: Copayment for Emergency Care $130 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $0 Copayment for Worldwide Emergency Transportation $0 |
| Ambulance Transportation | In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $290 Air Ambulance: Copayment for Air Ambulance Services $290 Prior Authorization Required for Air Ambulance |
Health Care Services and Medical Supplies
UHC Medicare Advantage TC-0001 (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 $15 Prior Authorization Required for Chiropractic Services Out-of-Network: Chiropractic Services: Copayment for Medicare Covered Chiropractic Services $85 |
| 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: Copayment for Medicare Covered Diagnostic Procedures/Tests $95 Copayment for Medicare Covered Lab Services $0 Copayment for Medicare Covered Diagnostic Radiological Services $375 Coinsurance for Medicare Covered Therapeutic Radiological Services 40% Copayment for Medicare Covered Outpatient X-Ray Services $50 |
| Home Health Care | In-Network: Home Health Services: Copayment for Medicare-covered Home Health Services $0 Prior Authorization Required for Home Health Services |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: $395 per day for days 1 to 5 $0 per day for days 6 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 | Out-of-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $625 Copayment for Medicare Covered Ambulatory Surgical Center Services $625 Benefit Details - General 9a1 Note - NOTE ON COST SHARING RANGE FOR OUTPATIENT HOSPITAL SERVICES: $0 copayment for outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures.Benefit Details - General 9a1 Note - NOTE ON OUTPATIENT HOSPITAL SERVICES: Benefit category includes both the facility and professional component. |
| 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: $0 copayment 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: $0 copayment 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: Copayment for Non-Medicare Covered Over-The-Counter (OTC) Items $0 |
| Podiatry Services | Out-of-Network: Podiatry Services: Copayment for Medicare Covered Podiatry Services $85 $45 copay 6 visits per year |
| 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 | Out-of-Network: Preventive Dental Services: Coinsurance for Medicare Covered Preventive Dental 40% |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | Routine Eye Exam: $0 copay 1 per year Routine Eyewear: $0 copay for standard prescription lenses $150 allowance every 2 years for 1 pair of lenses/frames or contacts. |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | Out-of-Network: Hearing Exams Services: Copayment for Medicare Covered Hearing Exams $85 |
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 | Out-of-Network: Medicare-covered Preventive Services: Coinsurance for Medicare Covered Medicare-covered Preventive Services 0% to 40% |
Prescription Drug Costs and Coverage
The UHC Medicare Advantage TC-0001 (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $440 (excludes Tiers 1 and 2) per year.
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual Drug Deductible | $440 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $440 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $440 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|