AARP Medicare Advantage Patriot No Rx NE-MA01 (PPO)

Nebraska Medicare Advantage Plan (2025 Plan)


Monthly Premium

Your Cost
$0
by UnitedHealthcareⓇ

Additional Coverage

HearingVisionDental

Overall Government Star Rating

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

AARP Medicare Advantage Patriot No Rx NE-MA01 (PPO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in Nebraska 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.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$6,700
Primary doctor visit
$0 copay
Specialist visit
$0-50 copay per visit
ER visit
$125 copay per visit (always covered)
Ambulance
$290 copay

AARP Medicare Advantage Patriot No Rx NE-MA01 (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 $10,100 In and Out-of-network $6,700 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 AARP Medicare Advantage Patriot No Rx NE-MA01 (PPO) are defined below.

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

AARP Medicare Advantage Patriot No Rx NE-MA01 (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. AARP Medicare Advantage Patriot No Rx NE-MA01 (PPO) includes coverage for hearing, vision, dental.

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

Other benefits

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

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$10,100 In and Out-of-network
$6,700 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $0-50 copay per visit
Out-of-network: $70 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $45 copay
Out-of-network: 40% coinsurance
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $0-250 copay
Out-of-network: 40% coinsurance
Outpatient x-rays
In-network: $25 copay
Out-of-network: $40 copay
Emergency care
$125 copay per visit (always covered)
Urgent care
$0-55 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $425 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 91 and beyond
Out-of-network: 40% per stay
Outpatient hospital coverage
In-network: $0-425 copay per visit
Out-of-network: 40% coinsurance 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: 0-40% coinsurance

Ambulance

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

Therapy services

Occupational therapy visit
In-network: $0-45 copay
Out-of-network: $70 copay
Physical therapy & speech & language therapy visit
In-network: $0-45 copay
Out-of-network: $70 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $10 copay
Out-of-network: $30 copay
Outpatient individual therapy with a psychiatrist
In-network: $0-10 copay
Out-of-network: $40 copay
Outpatient group therapy visit
In-network: $10 copay
Out-of-network: $30 copay
Outpatient individual therapy visit
In-network: $0-10 copay
Out-of-network: $40 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 per item
Out-of-network: 50% coinsurance per item

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: 40% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 0-40% coinsurance

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: $70 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
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Prosthodontics, fixed
In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Maxillofacial prosthetics
In-network: $0 copay
Out-of-network: $0 copay
Implant services
Not covered
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
Not covered
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: $70 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0-153 copay
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0-153 copay
Eyeglass lenses (only)
In-network: $0-153 copay
Out-of-network: $0-153 copay
Upgrades
Not covered

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