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H0294 - 017 - 0
(4.5 / 5)
AARP Medicare Advantage Open Plan 1 (PPO)is a Medicare Advantage (Part C) Plan by UnitedHealthcare.
This page features plan details for 2023 AARP Medicare Advantage Open Plan 1 (PPO)H0294 – 017 – 0 available in Detroit metro.
IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below:
2024 AARP Medicare Advantage from UHC MI-0001 (PPO) H0294 - 017 - 0
Locations
AARP Medicare Advantage Open Plan 1 (PPO)is offered in the following locations.
Genesee County, Michigan
Livingston County, Michigan
Michigan
Click to see more locations
Plan Overview
AARP Medicare Advantage Open Plan 1 (PPO)offers the following coverage and cost-sharing.
Insurer: | UnitedHealthcare |
Health Plan Deductible: | $0.00 |
MOOP: | $4,500 In and Out-of-network $4,500 In-network |
Drugs Covered: | Yes |
Ready to sign up for AARP Medicare Advantage Open Plan 1 (PPO)?
Get help from a licensed insurance agent.
Call 1-877-354-4611 TTY 711.
8am – 11pm EST. 7 days a week
Premium Breakdown
AARP Medicare Advantage Open Plan 1 (PPO)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 |
---|---|---|---|---|
$164.90 | $0.00 | $0.00 | $0.00 | $164.90 |
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 Open Plan 1 (PPO)provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $4,660.00 |
Catastrophic Coverage Limit: | $7,400.00 |
Drug Benefit Type: | Enhanced |
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 D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
---|---|---|---|---|
$0.00 | $43.40 | $34.80 | $26.30 | $17.70 |
Initial Coverage Phase
After you pay your $0.00 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 $4,660.00. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
60 Day
90 Day
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.
30 Day
90 Day
30 Day
90 Day
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 $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
Drug Type | Cost Share |
---|---|
Generic drugs | $4.15 copay or 5% (whichever costs more) |
Brand-name drugs | $10.35 copay or 5% (whichever costs more) |
Additional Benefits
AARP Medicare Advantage Open Plan 1 (PPO)also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
In-Network: No |
Dental (comprehensive)
Diagnostic services: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Diagnostic services: | Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Endodontics: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Endodontics: | Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Extractions: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Extractions: | Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Non-routine services: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Non-routine services: | Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Periodontics: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Periodontics: | Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Prosthodontics, other oral/maxillofacial surgery, other services: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Prosthodontics, other oral/maxillofacial surgery, other services: | Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Restorative services: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Restorative services: | Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Dental (preventive)
Cleaning: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Cleaning: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Dental x-ray(s): | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Dental x-ray(s): | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Fluoride treatment: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Fluoride treatment: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Oral exam: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Oral exam: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Diagnostic procedures/lab services/imaging
Diagnostic radiology services (e.g., MRI): | In-Network: $0-150 copay (authorization required) (referral not required) |
Diagnostic radiology services (e.g., MRI): | Out-of-Network: $0-150 copay (authorization required) (referral not required) |
Diagnostic tests and procedures: | In-Network: $25 copay (authorization required) (referral not required) |
Diagnostic tests and procedures: | Out-of-Network: $0-150 copay (authorization required) (referral not required) |
Lab services: | In-Network: $0 copay (authorization required) (referral not required) |
Lab services: | Out-of-Network: $0 copay (authorization required) (referral not required) |
Outpatient x-rays: | In-Network: $15 copay (authorization required) (referral not required) |
Outpatient x-rays: | Out-of-Network: $15 copay (authorization required) (referral not required) |
Doctor visits
Primary: | In-Network: $0 copay |
Primary: | Out-of-Network: $0 copay |
Specialist: | In-Network: $35 copay per visit (authorization required) (referral not required) |
Specialist: | Out-of-Network: $35 copay per visit (authorization required) (referral not required) |
Emergency care/Urgent care
Emergency: | $90 copay per visit (always covered) |
Urgent care: | $40 copay per visit (always covered) |
Foot care (podiatry services)
Foot exams and treatment: | In-Network: $35 copay (authorization required) (referral not required) |
Foot exams and treatment: | Out-of-Network: $35 copay (authorization required) (referral not required) |
Routine foot care: | In-Network: $35 copay (limits may apply) (authorization required) (referral not required) |
Routine foot care: | Out-of-Network: $35 copay (limits may apply) (authorization required) (referral not required) |
Ground ambulance
In-Network: $210 copay | |
Out-of-Network: $210 copay |
Health plan deductible
$0.00 |
Health plan deductibles (other)
In-Network: No |
Hearing
Fitting/evaluation: | Not covered (no limits) |
Hearing aids: | In-Network: $175-1,225 copay (limits may apply) (authorization required) (referral not required) |
Hearing aids: | Out-of-Network: $175-1,225 copay (limits may apply) (authorization required) (referral not required) |
Hearing exam: | In-Network: $0 copay (authorization required) (referral not required) |
Hearing exam: | Out-of-Network: $35 copay (authorization required) (referral not required) |
Hospital coverage (inpatient)
In-Network: $325 per day for days 1 through 6 $0 per day for days 7 through 90 $0 per day for days 91 and beyond (authorization required) (referral not required) | |
Out-of-Network: $325 per day for days 1 through 6 $0 per day for days 7 and beyond (authorization required) (referral not required) |
Hospital coverage (outpatient)
In-Network: $0-275 copay per visit (authorization required) (referral not required) | |
Out-of-Network: $0-275 copay per visit (authorization required) (referral not required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$4,500 In and Out-of-network $4,500 In-network |
Medical equipment/supplies
Diabetes supplies: | In-Network: $0 copay per item (authorization required) |
Diabetes supplies: | Out-of-Network: 50% coinsurance per item (authorization required) |
Durable medical equipment (e.g., wheelchairs, oxygen): | In-Network: 20% coinsurance per item (authorization required) |
Durable medical equipment (e.g., wheelchairs, oxygen): | Out-of-Network: 50% coinsurance per item (authorization required) |
Prosthetics (e.g., braces, artificial limbs): | In-Network: 20% coinsurance per item (authorization required) |
Prosthetics (e.g., braces, artificial limbs): | Out-of-Network: 50% coinsurance per item (authorization required) |
Medicare Part B drugs
Chemotherapy: | In-Network: 20% coinsurance (authorization required) |
Chemotherapy: | Out-of-Network: 0-20% coinsurance (authorization required) |
Other Part B drugs: | In-Network: 0-20% coinsurance (authorization required) |
Other Part B drugs: | Out-of-Network: 0-20% coinsurance (authorization required) |
Mental health services
Inpatient hospital – psychiatric: | In-Network: $325 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required) |
Inpatient hospital – psychiatric: | Out-of-Network: $325 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required) |
Outpatient group therapy visit: | In-Network: $0 copay (authorization required) (referral not required) |
Outpatient group therapy visit: | Out-of-Network: $0-5 copay (authorization required) (referral not required) |
Outpatient group therapy visit with a psychiatrist: | In-Network: $0 copay (authorization required) (referral not required) |
Outpatient group therapy visit with a psychiatrist: | Out-of-Network: $0-5 copay (authorization required) (referral not required) |
Outpatient individual therapy visit: | In-Network: $5 copay (authorization required) (referral not required) |
Outpatient individual therapy visit: | Out-of-Network: $0-5 copay (authorization required) (referral not required) |
Outpatient individual therapy visit with a psychiatrist: | In-Network: $5 copay (authorization required) (referral not required) |
Outpatient individual therapy visit with a psychiatrist: | Out-of-Network: $0-5 copay (authorization required) (referral not required) |
Optional supplemental benefits
No |
Preventive care
In-Network: $0 copay (authorization not required) (referral not required) | |
Out-of-Network: $0 copay (authorization not required) (referral not required) |
Rehabilitation services
Occupational therapy visit: | In-Network: $20 copay (authorization required) (referral not required) |
Occupational therapy visit: | Out-of-Network: $20 copay (authorization required) (referral not required) |
Physical therapy and speech and language therapy visit: | In-Network: $20 copay (authorization required) (referral not required) |
Physical therapy and speech and language therapy visit: | Out-of-Network: $20 copay (authorization required) (referral not required) |
Skilled Nursing Facility
In-Network: $0 per day for days 1 through 20 $196 per day for days 21 through 43 $0 per day for days 44 through 100 (authorization required) (referral not required) | |
Out-of-Network: $0 per day for days 1 through 20 $196 per day for days 21 through 43 $0 per day for days 44 through 100 (authorization required) (referral not required) |
Transportation
Not covered |
Vision
Contact lenses: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Contact lenses: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglass frames: | Not covered (no limits) |
Eyeglass lenses: | Not covered (no limits) |
Eyeglasses (frames and lenses): | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglasses (frames and lenses): | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Other: | Not covered (no limits) |
Routine eye exam: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Routine eye exam: | Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
Upgrades: | Not covered |
Wellness programs (e.g., fitness, nursing hotline)
Covered (authorization not required) (referral not required) |
Ready to sign up for AARP Medicare Advantage Open Plan 1 (PPO)?
Get help from a licensed insurance agent.
Call 1-877-354-4611 TTY 711.
8am – 11pm EST. 7 days a week