AARP Medicare Advantage Value (HMO-POS)

Medicare Plan Details

2021 Plan

Monthly Premium

(select county for price)

by UnitedHealthcare

Additional Coverage

Hearing Vision Dental

Overall Government Star Rating

4.0

out of 5 stars

State: Wisconsin

Select your county to view the price for this plan

Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

Monthly Premium

Health Portion of Premium

Drug Portion of Premium

Health Plan Deductible

Health Plan Max Out-of-Pocket

$4,900 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

http://www.AARPMedicarePlans.com

Plan Link

http://www.AARPMedicarePlans.com

Medical Benefits

Doctor Services

Primary doctor visit

In-network: $10 copay per visit
Out-of-network: No Data

Specialist visit

In-network: $50 copay per visit
Out-of-network: No Data

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $25 copay
Out-of-network: No Data

Lab services

In-network: $0 copay
Out-of-network: No Data

Diagnostic radiology services (like MRI)

In-network: $0-160 copay
Out-of-network: No Data

Outpatient x-rays

In-network: $15 copay
Out-of-network: No Data

Emergency care

$90 copay per visit (always covered)

Urgent care

$30-40 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: $420 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
Out-of-network: Not Applicable

Outpatient hospital coverage

In-network: $0-395 copay per visit
Out-of-network: No Data

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$184 per day for days 21 through 47
$0 per day for days 48 through 100
Out-of-network: Not Applicable

Preventive services

In-network: $0 copay
Out-of-network: No Data

Ambulance

Ground ambulance

In-network: $250 copay
Out-of-network: No Data

Therapy services

Occupational therapy visit

In-network: $40 copay
Out-of-network: No Data

Physical therapy & speech & language therapy visit

In-network: $40 copay
Out-of-network: No Data

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $10 copay
Out-of-network: No Data

Outpatient individual therapy with a psychiatrist

In-network: $15 copay
Out-of-network: No Data

Outpatient group therapy visit

In-network: $10 copay
Out-of-network: No Data

Outpatient individual therapy visit

In-network: $15 copay
Out-of-network: No Data

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 20% coinsurance per item
Out-of-network: No Data

Prosthetics (like braces, artificial limbs)

In-network: 20% coinsurance per item
Out-of-network: No Data

Diabetes supplies

In-network: $0 copay per item
Out-of-network: No Data

Prescription Drug Benefits

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

Tiers	Initial coverage phase	Gap coverage phase¹	Catastrophic coverage phase
Preferred Generic	$3.00 copay		Generic drugs : $3.70 copay or 5% (whichever costs more) Brand-name drugs : $9.20 copay or 5% (whichever costs more)
Generic	$14.00 copay	$14.00 copay
Preferred Brand	$47.00 copay
Non-Preferred Drug	$100.00 copay
Specialty Tier	26%
¹ * The above cost-sharing only applies to some drugs on this tier. For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Chemotherapy drugs

In-network: 20% coinsurance
Out-of-network: No Data

Other Part B drugs

In-network: 20% coinsurance
Out-of-network: No Data

Extra Benefits

Hearing

Hearing exam

In-network: $0 copay
Out-of-network: No Data

Fitting/evaluation

Not covered

Hearing aids - All types

In-network: $375-2,075 copay
Out-of-network: No Data

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

Non-routine services

Not covered

Diagnostic services

Not covered

Restorative services

Not covered

Endodontics

Not covered

Periodontics

Not covered

Extractions

Not covered

Prosthodontics, other oral/maxillofacial surgery, other services

Not covered

Vision

Routine eye exam

In-network: $0 copay
Out-of-network: No Data

Contact lenses

Not covered

Eyeglasses (frames & lenses)

Not covered

Eyeglass frames (only)

Not covered

Eyeglass lenses (only)

Not covered

Upgrades

Not covered

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

Limited coverage

Annual physical exams

Limited coverage

Telehealth

Limited coverage

Summary rating of health plan quality

Staying healthy: screenings, tests, & vaccines

Managing chronic (long term) conditions

Member experience with health plan

Member complaints & changes in the health plan's performance

Health plan customer service

Summary rating of drug plan quality

Drug plan customer service

Member complaints & changes in the drug plan's performance

Member experience with the drug plan

Drug safety & accuracy of drug pricing

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