AARP Medicare Advantage from UHC TC-0004 (HMO-POS)

H5253 - 121 - 0
4.5 out of 5 stars (4.5 / 5)

AARP Medicare Advantage from UHC TC-0004 (HMO-POS) is a Medicare Advantage (Part C) Plan by UnitedHealthcare.

This page features plan details for 2024 AARP Medicare Advantage from UHC TC-0004 (HMO-POS) H5253 – 121 – 0 available in Select Counties in Tennessee and Virginia.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

AARP Medicare Advantage from UHC TC-0004 (HMO-POS) is offered in the following locations.

Plan Overview

AARP Medicare Advantage from UHC TC-0004 (HMO-POS) offers the following coverage and cost-sharing.

Insurer:UnitedHealthcare
Health Plan Deductible:$0.00
MOOP:$6,300 In-network
Drugs Covered:Yes
Please Note:
  • This plan does not charge an annual deductible for all drugs. The $395.00 annual deductible only applies to drugs on certain tiers.

Ready to sign up for AARP Medicare Advantage from UHC TC-0004 (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

AARP Medicare Advantage from UHC TC-0004 (HMO-POS) qualifies for a monthly Medicare Give Back Benefit of $100.00.

Premium Reduction:$100.00

Premium Breakdown

AARP Medicare Advantage from UHC TC-0004 (HMO-POS) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$174.70 $0.00 $0.00 $100.00 $74.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

AARP Medicare Advantage from UHC TC-0004 (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:$395.00
Initial Coverage Limit:$5,030.00
Catastrophic Coverage Limit:$8,000.00
Drug Benefit Type:Enhanced Alternative
Additional Gap Coverage:Yes
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$

NOTE:  The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.

Initial Coverage Phase

After you pay your $395.00 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 $5,030.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.

Tier Cost
All other tiers (Generic)25%
All other tiers (Brand-name)25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

AARP Medicare Advantage from UHC TC-0004 (HMO-POS) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$6,300 In-network

Optional supplemental benefits

Yes

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network No

Outpatient hospital coverage

In-network $0-375 copay per visit (Authorization is required.) (Referral is not required.)

Doctor visits

In-network Primary$0 copay (Not applicable.) (Not applicable.)
In-network Specialist$0-45 copay per visit (Authorization is required.) (Referral is not required.)

Preventive care

In-network $0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$120 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$0-40 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures$40 copay (Authorization is required.) (Referral is not required.)
In-network Lab services$0 copay (Authorization is required.) (Referral is not required.)
In-network Diagnostic radiology services (e.g., MRI)$0-165 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient x-rays$15 copay (Authorization is required.) (Referral is not required.)

Hearing

In-network Hearing exam$0 copay (Authorization is required.) (Referral is not required.)
Fitting/evaluationNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Hearing aids$99-1,249 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Preventive dental

In-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

Non-routine servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Diagnostic servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Restorative servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
EndodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
PeriodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
ExtractionsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)

Vision

In-network Routine eye exam$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

In-network Occupational therapy visit$0-20 copay (Authorization is required.) (Referral is not required.)
In-network Physical therapy and speech and language therapy visit$0-20 copay (Authorization is required.) (Referral is not required.)

Ground ambulance

In-network $290 copay (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

In-network Foot exams and treatment$45 copay (Authorization is required.) (Referral is not required.)
In-network Routine foot care$45 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Diabetes supplies$0 copay per item (Authorization is required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
In-network Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
In-network Part B Insulin drugs0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

In-network $375 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond (Authorization is required.) (Referral is not required.)
out-of-network Not Applicable (Authorization is required.) (Referral is not required.)

Mental health services

In-network Inpatient hospital – psychiatric$375 per day for days 1 through 4
$0 per day for days 5 through 90 (Authorization is required.) (Referral is not required.)
out-of-network Inpatient hospital – psychiatricNot Applicable (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit with a psychiatrist$15 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit with a psychiatrist$0-25 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit$15 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit$0-25 copay (Authorization is required.) (Referral is not required.)

Skilled Nursing Facility

In-network $0 per day for days 1 through 20
$203 per day for days 21 through 100 (Authorization is required.) (Referral is not required.)
out-of-network Not Applicable (Authorization is required.) (Referral is not required.)

Package #1

Monthly Premium$56.00
Deductiblenan

Ready to sign up for AARP Medicare Advantage from UHC TC-0004 (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

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