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UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO)

Georgia Medicare Advantage Plan (2025 Plan)

Monthly Premium

Your Cost
$0
by UnitedHealthcareⓇ

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 3.5
out of 5 stars

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Plan Overview

Plan Name
UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO)
Insurance Carrier
UnitedHealthcareⓇ
Plan Type
Medicare Advantage Plan Without Prescription Drugs
Network Type
PPO

UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in Georgia and offered by the health insurance company UnitedHealthcareⓇ. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$9,350
Primary doctor visit
$0 copay
Specialist visit
$0-55 copay per visit
ER visit
$110 copay per visit (always covered)
Ambulance
$290 copay

UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $9,350 In and Out-of-network $9,350 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) are defined below.

Additional Benefits and Coverage

No
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Not covered
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Comparing the Quality Score of UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) to Other Plans in Georgia

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) received an overall government quality rating of 3.5 stars out of 5 stars.

UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) performed worse than Georgia’s State average overall quality score of 3.8 stars.

This Plan’s 5-star Gov’t Quality Score
Georgia State Average Score
Overall Government 5 Star Quality Rating
 3.5
 3.8
Summary rating of health plan quality
 3.5
 3.8
Staying healthy: screenings, tests, & vaccines
 4
 3.7
Managing chronic (long term) conditions
 3
 3.5
Member experience with health plan
 4
 3.9
Member complaints & changes in the health plan's performance
 3
 3.8
Health plan customer service
 4
 4.2

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) received 3.5 stars for its health plan quality score which is worse than the Georgia State average health plan quality score of 3.8 stars.

Plan Benefits and Coverage Details

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$9,350 In and Out-of-network
$9,350 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
http://UHC.com/Medicare
Plan Link
http://UHC.com/Medicare

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $0-55 copay per visit
Out-of-network: $55 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $50 copay
Out-of-network: $50 copay
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $0-225 copay
Out-of-network: $0-225 copay
Outpatient x-rays
In-network: $40 copay
Out-of-network: $40 copay
Emergency care
$110 copay per visit (always covered)
Urgent care
$0-45 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $475 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: $475 per day for days 1 through 5
$0 per day for days 6 and beyond
Outpatient hospital coverage
In-network: $0-475 copay per visit
Out-of-network: $0-475 copay per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Out-of-network: $225 per day for days 1 through 100

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance
In-network: $290 copay
Out-of-network: $290 copay

Therapy services

Occupational therapy visit
In-network: $0-35 copay
Out-of-network: $35 copay
Physical therapy & speech & language therapy visit
In-network: $0-50 copay
Out-of-network: $50 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $15 copay
Out-of-network: $15 copay
Outpatient individual therapy with a psychiatrist
In-network: $0-25 copay
Out-of-network: $25 copay
Outpatient group therapy visit
In-network: $15 copay
Out-of-network: $15 copay
Outpatient individual therapy visit
In-network: $0-25 copay
Out-of-network: $25 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 50% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 50% coinsurance per item
Diabetes supplies
In-network: $0 copay
Out-of-network: 50% coinsurance per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 0-20% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: $55 copay
Fitting/evaluation
Not covered
Hearing aids - All types
In-network: $199-1,249 copay
Out-of-network: $199-1,249 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)
In-network: $0-153 copay
Out-of-network: $0 copay
Upgrades
Not covered

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