AARP Medicare Advantage Choice Plan 2 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H2228-036-000
Pennsylvania Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.
Learn more about Pennsylvania Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
|Monthly plan premium||$44.00|
|Initial drug coverage limit||$0.00|
|Catastrophic drug coverage limit||$7,400.00|
|Primary care doctor visit||In-Network:|
Doctor Office Visit:
Copayment for Primary Care Office Visit $0.00
|Specialty doctor visit|
Doctor Specialty Visit:
Copayment for Medicare Covered Physician Specialist Office Visit $55.00
|Inpatient hospital care||In-Network:|
Acute Hospital Services:
Copayment for Acute Hospital Services per Stay $350.00
Your plan covers an unlimited number of days for an inpatient stay.
Prior Authorization Required for Acute Hospital Services
Copayment for Urgent Care $40.00
Copayment for Worldwide Urgent Coverage $0.00
|Emergency room visit|
Copayment for Emergency Care $90.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours
Copayment for Worldwide Emergency Coverage $0.00
Copayment for Worldwide Emergency Transportation $0.00
Copayment for Ground Ambulance Services $250.00
Copayment for Air Ambulance Services $250.00
Section B - General 10a Note - NOTE ON AUTHORIZATION: Authorization is required for Non-emergency Medicare-covered ambulance ground and air transportation. Emergency Ambulance does not require authorization.
Please see Evidence of Coverage for Prior Authorization rules
AARP Medicare Advantage Choice Plan 2 (PPO) covers a range of additional benefits. Learn more about AARP Medicare Advantage Choice Plan 2 (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
Copayment for Medicare-covered Chiropractic Services $20.00
Prior Authorization Required for Chiropractic Services
|Diabetes supplies, training, nutrition therapy and monitoring||In-Network:|
Diabetic Supplies and Services:
Copayment for Medicare-covered Diabetic Supplies $0.00
Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20%
Prior Authorization Required for Diabetic Supplies and Services
Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage)
|Durable medical equipment (DME)||In-Network:|
Durable Medical Equipment:
Coinsurance for Medicare-covered Durable Medical Equipment 20%
Prior Authorization Required for Durable Medical Equipment
|Diagnostic tests, lab and radiology services, and X-rays|
Outpatient Diag Procs/Tests/Lab Services:
Coinsurance for Medicare Covered Diagnostic Procedures/Tests
Copayment for Medicare Covered Lab Services
Coinsurance for Medicare Covered Diagnostic Radiological Services 30%
Coinsurance for Medicare Covered Therapeutic Radiological Services 30%
Copayment for Medicare Covered Outpatient X-Ray Services $20.00
|Home health care|
Home Health Services:
Coinsurance for Medicare Covered Home Health 50%
|Mental health inpatient care|
Coinsurance for Psychiatric Hospital Services per Stay 30%
|Mental health outpatient care||In-Network:|
Outpatient Mental Health Services:
Copayment for Medicare-covered Individual Sessions $25.00
Copayment for Medicare-covered Group Sessions $15.00
Prior Authorization Required for Outpatient Mental Health Services
Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0.00 to $295.00
Prior Authorization Required for Outpatient Hospital Services
Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per day $295.00
Prior Authorization Required for Outpatient Observation Services
Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0.00 to $200.00
Prior Authorization Required for Ambulatory Surgical Center Services
|Outpatient substance abuse care|
Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual or Group Sessions $30.00 to $40.00
Over-The-Counter (OTC) Items:
Copayment for Non-Medicare Covered Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $90.00
Copayment for Medicare Covered Podiatry Services $55.00
Copayment for Non-Medicare Covered Podiatry Services $55.00
|Skilled Nursing Facility (SNF) care|
$225.00 per day for days 1 to 40
$0.00 per day for days 41 to 100
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Copayment for Oral Exams $0.00
Coinsurance for Medicare-covered Benefits 20%
Copayment for Non-routine Services $0.00
Copayment for Diagnostic Services $0.00
Prior Authorization Required for Comprehensive Dental
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Copayment for Medicare Covered Benefits $0.00
Copayment for Routine Eye Exams $0.00
Copayment for Medicare-Covered Benefits $0.00
Copayment for Contact Lenses $0.00
Copayment for Eyeglasses (lenses and frames) $0.00
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
Copayment for Medicare Covered Benefits $0.00
Copayment for Routine Hearing Exams $0.00
Copayment for Hearing Aids $175.00 to $1225.00
Section B - General 18b Note - NOTE ON COST SHARING: Copays will range from a minimum copay of $175 to a maximum of $1,225 based on features and style. NOTE ON COMBINED COVERAGE FOR HEARING AID BENEFIT: Member may purchase a total of two hearing aids every year.
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
|Preventive services and health/wellness education programs|
Medicare-covered Zero Dollar Preventive Services:
Coinsurance for Medicare Covered Medicare-covered Preventive Services 0% to 30%
When reviewing Pennsylvania Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.
You may be able to find plans in your part of Pennsylvania that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
|Links to plan documents|
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