2027 Medicare Advantage plan
AARP Medicare Advantage Patriot No Rx IN-MA01 (PPO): 2027 benefits and costs
UnitedHealthcare PPO
CMS plan ID: H2406-074-0 · Plan year: 2027
AARP Medicare Advantage Patriot No Rx IN-MA01 (PPO) is a 2027 Medicare Advantage plan offered by UnitedHealthcare. It is listed in Indiana.
2027 plan costs at a glance
- Organization
- UnitedHealthcare
- Plan organization
- CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.
- Parent company
- UnitedHealth Group, Inc.
- Plan type
- PPO
- Part C premium
- $0.00
- Prescription drug coverage
- No
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
- Monthly Part B premium after plan reduction
- $19.50 (estimated)$209.50 standard premium less $190.00 plan reduction.
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- $1,000.00
Applies to out-of-network Medicare-covered services; out-of-network $0 preventive care is exempt.
- In-network medical maximum
- $9,850.00
- Combined in/out-of-network medical maximum
- $14,800.00
- Out-of-network medical maximum
- Not applicable
- Part B premium reduction
- $190.00
2027 benefit summary
Doctor visits and medical care
Plan-level deductibles may still apply when a service-specific deductible is listed as No.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | $0.00 copay
| $25.00 copay
| |
| Specialist visit | $0.00 to $60.00 copay
| $75.00 copay
|
|
| Emergency care | $115.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $0.00 to $40.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0.00 copay
| 50% coinsurance
|
|
| Dialysis | 20% coinsurance
| 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 40% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 0% to 40% coinsurance
|
|
| Kidney disease education services | $0.00 copay
| 40% coinsurance
|
|
| Medicare-covered chiropractic | $15.00 copay
| $75.00 copay
|
|
| Medicare-covered foot care | $45.00 copay
| $75.00 copay
|
|
| Other health professionals | $0.00 to $60.00 copay
| $25.00 to $75.00 copay
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–5: $490.00 copay per day Days 6–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–4: $490.00 copay per day Days 5–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | $0.00 to $490.00 copay
| 40% coinsurance
| |
| Hospital observation services | $490.00 copay
| 40% coinsurance
| |
| Ambulatory surgical center | $0.00 to $340.00 copay
| 40% coinsurance
|
|
| Outpatient blood | $0.00 copay
| $0.00 copay
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $50.00 copay
| 40% coinsurance
|
|
| Laboratory services | $0.00 copay
| $0.00 copay
|
|
| Diagnostic radiology (CT, MRI) | $0.00 to $320.00 copay
| 40% coinsurance
|
|
| Therapeutic radiology | 20% coinsurance
| 40% coinsurance
|
|
| X-rays | $30.00 copay
| $50.00 copay
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $55.00 copay
| $75.00 copay
|
|
| Intensive outpatient program | $55.00 copay
| $75.00 copay
|
|
| Substance use treatment, individual sessions | $0.00 to $25.00 copay
| $40.00 copay
|
|
| Substance use treatment, group sessions | $15.00 copay
| $30.00 copay
|
|
| Opioid treatment program | $0.00 copay
| $0.00 copay
|
|
| Mental health, individual sessions | $0.00 to $25.00 copay
| $40.00 copay
|
|
| Mental health, group sessions | $15.00 copay
| $30.00 copay
|
|
| Psychiatry, individual sessions | $0.00 to $25.00 copay
| $40.00 copay
|
|
| Psychiatry, group sessions | $15.00 copay
| $30.00 copay
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $35.00 copay
| $75.00 copay
|
|
| Physical and speech therapy | $55.00 copay
| $75.00 copay
|
|
| Cardiac rehabilitation | $0.00 copay
| 40% coinsurance
|
|
| Intensive cardiac rehabilitation | $0.00 copay
| 40% coinsurance
|
|
| Pulmonary rehabilitation | $0.00 copay
| 40% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $0.00 copay
| 40% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $350.00 copay
| $350.00 copay
|
|
| Air ambulance | $350.00 copay
| $350.00 copay
|
|
| Durable medical equipment | 20% coinsurance
| 50% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 50% coinsurance
|
|
| Medical supplies | 20% coinsurance
| 50% coinsurance
|
|
| Diabetic supplies | $0.00 copay
| 50% coinsurance
|
|
| Diabetic shoes and inserts | 20% coinsurance
| 50% coinsurance
|
|
| Diabetic monitors | $0.00 copay
| 50% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | 20% coinsurance | 40% coinsurance
| |
| Oral examsAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Dental X-raysAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Other diagnostic dentalAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Dental cleaningAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| FluorideAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Other preventive dentalAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Restorative dental careAdditional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Removable dentures (prosthodontics)Additional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Maxillofacial prostheticsAdditional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Oral surgeryAdditional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Other dental servicesAdditional plan benefit | 50% coinsurance | 50% coinsurance
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Comprehensive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $0.00 copay
| $75.00 copay
|
|
| Routine eye examsAdditional plan benefit | $0.00 copay | $75.00 copay
|
|
| Medicare-covered eyewear | $0.00 copay
| 40% coinsurance
|
|
| Contact lensesAdditional plan benefit | $0.00 copay | 90% coinsurance
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0.00 copay | 90% coinsurance
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $0.00 copay
| $75.00 copay
|
|
| Routine hearing examsAdditional plan benefit | $0.00 copay | $75.00 copay
|
|
| Prescription hearing aids (all types)Additional plan benefit | $0.00 copay
| 90% coinsurance
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0.00 copay
| 90% coinsurance
| |
| Annual physical examAdditional plan benefit | $0.00 copay
| 40% coinsurance
|
|
| Fitness benefitAdditional plan benefit | $0.00 copay
| 90% coinsurance
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Podiatry Services - Routine Foot CareAdditional plan benefit | Out-of-network | $75.00 copay
|
|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | 0% to 40% coinsurance
| |
| Home and Bathroom Safety Devices and ModificationsAdditional plan benefit | Out-of-network | 90% coinsurance
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | $75.00 copay
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | 40% coinsurance
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | 40% coinsurance
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | 40% coinsurance
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | 40% coinsurance
|
Allowances and optional benefits
Combined Benefit 1
One shared limit covers the listed services, not a separate allowance for each service.
- Services sharing this allowance
- Over-the-counter health items; Home and Bathroom Safety Devices and Modifications
- How benefits are provided
- Catalogue Purchase; Debit Card
- Advance choice of benefits required
- No
- Shared benefit limit
- $140.00
- How often this limit applies
- Every three months
- Shared limit on visits or trips
- No
Prescription drug coverage
This plan does not include a Part D prescription drug benefit.
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.
View all locations 63 county listings across 1 state or territory
Indiana
- Allen, Indiana
- Bartholomew, Indiana
- Benton, Indiana
- Blackford, Indiana
- Boone, Indiana
- Brown, Indiana
- Carroll, Indiana
- Clark, Indiana
- Clinton, Indiana
- Crawford, Indiana
- Daviess, Indiana
- Dearborn, Indiana
- DeKalb, Indiana
- Delaware, Indiana
- Dubois, Indiana
- Elkhart, Indiana
- Fayette, Indiana
- Floyd, Indiana
- Fountain, Indiana
- Fulton, Indiana
- Gibson, Indiana
- Grant, Indiana
- Hamilton, Indiana
- Hancock, Indiana
- Hendricks, Indiana
- Henry, Indiana
- Howard, Indiana
- Huntington, Indiana
- Jasper, Indiana
- Jay, Indiana
- Jennings, Indiana
- Johnson, Indiana
- Knox, Indiana
- Kosciusko, Indiana
- Lake, Indiana
- Madison, Indiana
- Marion, Indiana
- Marshall, Indiana
- Martin, Indiana
- Montgomery, Indiana
- Morgan, Indiana
- Noble, Indiana
- Ohio, Indiana
- Orange, Indiana
- Perry, Indiana
- Pike, Indiana
- Porter, Indiana
- Posey, Indiana
- Pulaski, Indiana
- Randolph, Indiana
- Scott, Indiana
- Spencer, Indiana
- St. Joseph, Indiana
- Switzerland, Indiana
- Tippecanoe, Indiana
- Tipton, Indiana
- Vanderburgh, Indiana
- Warren, Indiana
- Warrick, Indiana
- Washington, Indiana
- Wells, Indiana
- White, Indiana
- Whitley, Indiana