Coverage and Benefits

Get a quick overview of your plan benefits and costs and find more detailed information about additional benefits and programs.

Important Information about your Part D Vaccine and Insulin Coverage 

What You Pay for Vaccines – Our plan covers most adult Part D vaccines at no cost to you.

What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan. Refer to your plan materials.

 

UnitedHealthcare® Group Medicare Advantage (PPO) - MAPD

2024 materials

Enhanced and Essential plan materials

While you do have a choice, the Enhanced Plan may be the best option for most participants, based on its low copays and out of pocket maximum.

Plan options and costs

Plan options and costs
Benefits and Costs

UnitedHealthcare Group Medicare Advantage (PPO) – Enhanced Plan

UnitedHealthcare Group Medicare Advantage (PPO) – Essential Plan

UnitedHealthcare Group Medicare Advantage (PPO) – Enhanced Plan

UnitedHealthcare Group Medicare Advantage (PPO) – Essential Plan

Annual medical deductible

$0

$0

Annual medical deductible

$0

$0

Annual out-of-pocket maximum

$750

$5,000

Annual out-of-pocket maximum

$750

$5,000

Office and clinic visits

$5 copay for primary

$30 for specialist

$10 copay for primary

$40 for specialist

Office and clinic visits

$5 copay for primary

$30 for specialist

$10 copay for primary

$40 for specialist

Hospital services (inpatient)

$250 copay per stay

$275 copay per day: days 1–5

$0 copay per day after that

Hospital services (inpatient)

$250 copay per stay

$275 copay per day: days 1–5

$0 copay per day after that

Hospital services (outpatient)

$100 copay

$275 copay

Hospital services (outpatient)

$100 copay

$275 copay

Prescription drug coverage

Retail

Tier 1: $0 copay

Tier 2: $8 copay

Tier 3: $40 copay

Tier 4: $90 copay

Tier 5: 30% coinsurance

Mail Order

Tier 1: $0 copay

Tier 2: $16 copay

Tier 3: $80 copay

Tier 4: 180 copay

Tier 5: 30% coinsurance

Retail:

$5 copay

$15 copay

$47 copay

$100 copay

30% coinsurance

Mail Order:

$0 copay

$37.50 copay

$117.50 copay

$250 copay

30% coinsurance

Prescription drug coverage

Retail

Tier 1: $0 copay

Tier 2: $8 copay

Tier 3: $40 copay

Tier 4: $90 copay

Tier 5: 30% coinsurance

Mail Order

Tier 1: $0 copay

Tier 2: $16 copay

Tier 3: $80 copay

Tier 4: 180 copay

Tier 5: 30% coinsurance

Retail:

$5 copay

$15 copay

$47 copay

$100 copay

30% coinsurance

Mail Order:

$0 copay

$37.50 copay

$117.50 copay

$250 copay

30% coinsurance

Annual prescription (Part D ) deductible

$0 for Tier 1 and Tier 2
$50 for Tier 3, Tier 4 and Tier 5

$0 for Tier 1 and Tier 2
$395 for Tier 3, Tier 4 and Tier 5

Annual prescription (Part D ) deductible

$0 for Tier 1 and Tier 2
$50 for Tier 3, Tier 4 and Tier 5

$0 for Tier 1 and Tier 2
$395 for Tier 3, Tier 4 and Tier 5

For additional information on the IBM subsidy and how it applies to with these new plan options refer to the Enrollment Brochure or call the IBM Retiree Call Center at 1-877-852-0641. TTY users, call 711.

Preventive services

The following preventive services are covered under your plan for a $0 copay when you visit your primary care provider:

  • Annual Wellness Exam
  • Annual Routine Physical
  • Screenings for certain Cancers (Prostate, colorectal, breast cancer)
  • Screening for diabetes
  • Smoking and Tobacco Use Cessation

For more information about these preventive services, please call the Customer Service number on your member ID card.

Disclaimer

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the costsharing that applies to out-of-network services.