UnitedHealthcare® Group Medicare Advantage PPO (MPO) plan
How it works
Here are some highlights about this plan. Refer to the plan documents for additional details.
- This is a national plan covering all eligible beneficiaries regardless of where they reside in the U.S., D.C. and five U.S. territories.
- You can visit doctors, specialists, and hospitals in or out of the UnitedHealthcare network for the same cost share as long as the provider participates in Medicare and accepts the plan.
- Referrals are not required to see a specialist.
- Part D prescription drug coverage is included.
- Routine vision, hearing, podiatry, and many other benefits are included.
See the Summary of Benefits on pages 39–44 or refer to the plan documents for additional details.
Are you eligible?
- Retirees and eligible spouses, ages 65 or older, and enrolled in Medicare Part A and Part B.
- Those under 65 who qualify for Medicare due to disability or other special circumstances.
- You must reside in the United States, District of Columbia, or U.S. territories.
- If you are enrolling for the first time, you must complete a Retiree Health Benefit Enrollment form no more than 60 days before your retiree health benefits become effective.
- If you are already enrolled in this group plan, you do not need to take any action.
UnitedHealthcare® Group Medicare Advantage HMO (PMA) plan
How it works
Here are some highlights about this plan. Refer to the plan documents for additional details.
- You must reside in the one of the Texas counties listed at right to be eligible for this plan.
- You are required to select a primary care provider (PCP) to coordinate your care.
- You must utilize providers participating in the UnitedHealthcare Group Medicare Advantage HMO (PMA) network to receive covered services. Go to UHCRetiree.com to find a participating provider.
- Referrals are required to see a specialist.
- Part D prescription drug coverage is included.
- Routine vision, hearing, podiatry, and many other benefits are included.
See the Summary of Benefits on pages 39–44 or refer to the plan documents for additional details.
Are you eligible?
- Retirees and eligible spouses, ages 65 or older, and enrolled in Medicare Part A and Part B.
- Those under 65 who qualify for Medicare due to disability or other special circumstances.
- You must reside in one of these Texas counties: Angelina, Aransas, Atascosa, Bandera, Bee, Bexar, Collin, Comal, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Gregg, Guadalupe, Henderson, Hood, Houston, Hunt, Jim Wells, Johnson, Kaufman, Kendall, Kerr, Kleberg, Medina, Nacogdoches, Navarro, Nueces, Panola, Parker, Polk, Rockwall, Rusk, San Augustine, San Jacinto, San Patricio, Shelby, Smith, Tarrant, Trinity, Tyler, Van Zandt, Victoria, Walker, Wilson and Wise.
- If you are enrolling for the first time, you must complete a Retiree Health Benefit Enrollment form and UnitedHealthcare Group Medicare Advantage HMO (PMA) Enrollment Request form (included in your enrollment packet) prior to your coverage becoming effective. If you are already enrolled in this group plan, you do not need to complete another Group Medicare Advantage Enrollment Request form.
Retirees age 65 and older
PEBC’s UnitedHealthcare Group Medicare Advantage PPO (MPO) and Medicare Advantage HMO (PMA) plans include prescription drug benefits. During annual enrollment, if you are changing from the PPO plan or HDP to one of the PEBC Medicare Advantage plans and you use a mail order pharmacy, make sure you have a supply of medication on hand to carry you through the month of January. If you use home delivery, mail a new prescription to Optum Rx® — even if your current CVS prescription is not expired.
UnitedHealthcare Group Medicare Advantage plans
When you enroll in the UnitedHealthcare Medicare Advantage PPO (MPO) and Medicare Advantage HMO (PMA) plans, you are automatically enrolled in a Medicare-approved Part D prescription drug benefit offered through UnitedHealthcare.
No coverage gap or deductible
The PEBC group Medicare Advantage PPO (MPO) and Medicare Advantage HMO (PMA) plans include Part D coverage, but it may not be the same Part D plan offered elsewhere. Your prescription drug benefits are not subject to the coverage gap or deductible. In 2023, your standard copay remains in place until you pay $7,400 in total drug costs. After that, your copay reduces to $4.15 for generic and $10.35 for all other drugs. These amounts are subject to change based on federal Part D requirements.
Spouse and dependent coverage
As long as a retiree enrolls in either UnitedHealthcare Medicare Advantage plan, the non-Medicare spouse and/or dependent(s) can enroll in the PEBC PPO plan. Spouses and dependents enrolled in the PPO plan or HDP use the CVS Caremark National Preferred Formulary.
Additional benefits included with the Group Medicare Advantage PPO (MPO) and HMO (PMA) plans, not covered by Medicare
Fitness program
Renew Active® is the gold standard in Medicare fitness programs for body and mind. And it’s available with your Medicare Advantage PPO (MPO) and Medicare Advantage HMO (PMA) plan at no additional cost.
UnitedHealthcare Healthy at Home
UnitedHealthcare Healthy at Home, is a new program that is now included in your benefits at no additional cost, designed to help retirees safely transition back home after being discharged from a hospital or skilled nursing facility.
- Our Post-Discharge Meal Delivery benefit administered through Mom’s Meals® includes two meals per day for two weeks for members following all inpatient or skilled nursing facility discharges when referred by a UnitedHealthcare advocate.
- Our Post-Discharge Transportation benefit includes 12 rides to and from medically related appointments and pharmacies for our members up to 30 days following inpatient or skilled nursing facility discharges.
- Our In-home Personal Care benefit administered through our national partner CareLinx and offered exclusively to UnitedHealthcare Group Medicare Advantage members includes up to six hours of personal care post-discharge, provided by a CareLinx professional caregiver. This may include grocery shopping, meal preparation, light housekeeping, personal care, medication reminders and more. CareLinx is our national vendor providing a network of over 300,000 background-checked professional caregivers.
Hearing aids
As part of your health plan, you have a $500 allowance every three years to use toward the maintenance and purchase of hearing aids through UnitedHealthcare Hearing. With a large selection of private-labeled and name-brand hearing aids and convenient home delivery or in-person care options, you can choose what works best for your hearing loss needs. Call 1-855-523-9355, TTY 711, or visit UHCHearing.com to learn more.
For more information on the additional benefits, please click here.
