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AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO)

H1278 - 026 - 0
4 out of 5 stars (4 / 5)

AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) is a Medicare Advantage Plan by UnitedHealthcare.

This page features plan details for 2025 AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) H1278 – 026 – 0 available in Select Counties in Texas.

Locations

AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) is offered in the following locations.

Atascosa County, Texas
Bandera County, Texas
Bexar County, Texas

Click to see more locations

Plan Overview

AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) offers the following coverage and cost-sharing.

Insurer:UnitedHealthcare
Health Plan Deductible:$0
MOOP:$14,000 In and Out-of-network
$7,500 In-network
Drugs Covered:No

Ready to sign up for AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) qualifies for a monthly Medicare Give Back Benefit of $75.00.

Premium Reduction:$75.00

Premium Breakdown

AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$185.00 $0.00 $75.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)
  • Endodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)
  • Maxillofacial Prosthetics
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)
  • Maxillofacial Prosthetics
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)
  • Periodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)
  • Prosthodontics, fixed
    • In-Network: 0-50 Coins – No Co pay (Authorization Required)
  • Prosthodontics, removable
    • In-Network: 0-50 Coins – No Co pay (Authorization Required)
  • Restorative Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Fluoride Treatment
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Oral Exams
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Other Preventive Dental Services
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay

Diagnostic procedures/lab services/imaging

  • Lab services
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: $0 copay (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $50 copay (Authorization Required)
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-250 copay (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: $30 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Outpatient x-rays
    • In-Network: $25 copay (Authorization Required)

Doctor visits

  • Specialist
    • Out-of-Network: $70 copay per visit (Authorization Required)
    • In-Network: $0-55 copay per visit (Authorization Required)
  • Primary
    • In-Network: $0 copay
    • Out-of-Network: $25 copay per visit

Emergency care/Urgent care

  • Emergency
    • $110 copay per visit (always covered)
  • Urgent care
    • $0-45 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $45 copay (Authorization Required)
    • Out-of-Network: $70 copay (Authorization Required)
  • Routine foot care
    • In-Network: $45 copay (Limits Apply, Authorization Required)

Ground ambulance

    • In-Network: $275 copay
    • Out-of-Network: $275 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • Not covered
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $70 copay (Authorization Required)
  • Hearing aids
    • Out-of-Network: $199-1,249 copay (Limits Apply, Authorization Required)
  • Medicare-Covered Hearing Exam
    • In-Network: $0 copay (Authorization Required)
  • Hearing aids
    • In-Network: $199-1,249 copay (Limits Apply, Authorization Required)
  • Hearing aids OTC
    • Out-of-Network: $99-829 copay (Limits Apply)
    • In-Network: $99-829 copay (Limits Apply)

Inpatient hospital coverage

    • In-Network: $395 per day for days 1 through 6
      $0 per day for days 7 through 90
      $0 per day for days 91 and beyond (Authorization Required)
    • Out-of-Network: $500 per day for days 1 through 28
      $0 per day for days 29 and beyond (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $14,000 In and Out-of-network
      $7,500 In-network

Medical equipment/supplies

  • Diabetes supplies
    • In-Network: $0 copay per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Other Part B drugs
    • Out-of-Network: 0-40% coinsurance (Authorization Required)
  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: $30 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $0-25 copay (Authorization Required)
  • Inpatient hospital – psychiatric
    • In-Network: $395 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: $500 per day for days 1 through 28
      $0 per day for days 29 through 90 (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: $40 copay (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: $30 copay (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $0-25 copay (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $15 copay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $15 copay (Authorization Required)
  • Outpatient individual therapy visit
    • Out-of-Network: $40 copay (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $0-395 copay per visit (Authorization Required)
    • Out-of-Network: 40% coinsurance per visit (Authorization Required)

Preventive care

    • Out-of-Network: 0-40% coinsurance
    • In-Network: $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • Out-of-Network: $70 copay (Authorization Required)
    • In-Network: $0-50 copay (Authorization Required)
  • Occupational therapy visit
    • In-Network: $0-35 copay (Authorization Required)
    • Out-of-Network: $70 copay (Authorization Required)

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $203 per day for days 21 through 100 (Authorization Required)
    • Out-of-Network: $225 per day for days 1 through 100 (Authorization Required)

Transportation

    • Out-of-Network: 75% coinsurance (Limits Apply)
    • In-Network: $0 copay (Limits Apply)

Vision

  • Routine eye exam
    • Out-of-Network: $70 copay (Limits Apply, Authorization Required)
  • Eyeglass lenses
    • Not covered
  • Eyeglasses (frames and lenses)
    • Not covered
  • Upgrades
    • Not covered
  • Contact lenses
    • Not covered
  • Eyeglass frames
    • Not covered
  • Other
    • Not covered
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply, Authorization Required)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO)? See 2025 AARP Medicare Advantage Patriot No Rx TX-MA04 (PPO) at MedicareAdvantageRX.com.

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