UHC Medicare Advantage TX-0030 (Regional PPO)
UHC Medicare Advantage TX-0030 (Regional PPO) R6801-012 Plan Details
UHC Medicare Advantage TX-0030 (Regional PPO) is a Regional PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: R6801-012
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
$64.00
Monthly Premium
UHC Medicare Advantage TX-0030 (Regional PPO) is a Regional PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: R6801-012
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
UHC Medicare Advantage TX-0030 (Regional PPO) R6801-012 Plan Details
UHC Medicare Advantage TX-0030 (Regional PPO) is a Regional PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: R6801-012
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
$64.00
Monthly Premium
Texas Counties Served
El Paso
Hardin
Jackson
Yoakum
Austin
Matagorda
Wharton
Galveston
Washington
Jefferson
Travis
Orange
Frio
Dawson
Taylor
Live Oak
Lavaca
Sherman
Bexar
Culberson
Jones
Comal
Stonewall
Blanco
Collin
Dallas
Denton
Rockwall
Tarrant
Guadalupe
Hays
San Patricio
Upton
Freestone
Newton
Walker
Clay
Johnson
Polk
Bastrop
Caldwell
Kinney
Moore
Runnels
Knox
Cooke
Haskell
Archer
Bell
Baylor
Eastland
Stephens
Comanche
Brown
Hall
Lampasas
Callahan
Coleman
Falls
Deaf Smith
Williamson
Hansford
Milam
Hutchinson
Coryell
Oldham
Mclennan
Burnet
Burleson
Llano
Lee
Hartley
Dallam
Concho
Schleicher
Menard
Sutton
Kerr
Tom Green
Edwards
Reagan
Carson
Roberts
King
Harris
Fort Bend
Montgomery
Motley
Cottle
San Jacinto
Liberty
Chambers
Waller
Hudspeth
Gillespie
Mills
Mason
San Saba
Kendall
Dona Ana
Atascosa
Medina
Bandera
Wilson
Brazoria
Hidalgo
Grayson
Van Zandt
Ellis
Kaufman
Hunt
Fannin
Montague
Parker
Wise
Somervell
Hood
Bosque
Palo Pinto
Jack
Erath
Hamilton
La Salle
Mcmullen
Real
Karnes
Gonzales
Nacogdoches
Angelina
Tyler
Jasper
Colorado
Crosby
Lubbock
Calhoun
Hockley
Scurry
Brazos
Webb
Terry
Victoria
Goliad
Refugio
De Witt
Garza
Martin
Borden
Lynn
Kent
Glasscock
Zapata
Howard
Smith
Bee
Nolan
Navarro
Red River
Sabine
Fisher
Andrews
Henderson
Anderson
Nueces
Lamar
Jim Wells
Delta
Duval
Kenedy
Rains
Wood
Hopkins
Upshur
Camp
Cherokee
Morris
Gregg
Titus
Franklin
Aransas
Midland
Bowie
Cass
Marion
Harrison
Rusk
Brooks
Panola
Kleberg
Shelby
Leon
Limestone
Jim Hogg
Reeves
Trinity
San Augustine
Pecos
Houston
Cameron
Madison
Starr
Willacy
Uvalde
Ward
Hill
Irion
Dimmit
Maverick
Ochiltree
Throckmorton
Wilbarger
Wichita
Zavala
Young
Terrell
Crane
Foard
Shackelford
Fayette
Lipscomb
Gray
Parmer
Swisher
Dickens
Jeff Davis
Wheeler
Hemphill
Ector
Hardeman
Potter
Robertson
Randall
Donley
Hale
Lamb
Armstrong
Mcculloch
Briscoe
Castro
Kimble
Bailey
Val Verde
Floyd
Gaines
Crockett
Coke
Collingsworth
Loving
Mitchell
Winkler
Brewster
Sterling
Cochran
Childress
Presidio
Grimes
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $570 |
| Out of Pocket Max |
In-Network: $7900 Out-of-Network: N/A |
| Initial Coverage Limit | $2000 |
| Catastrophic Coverage Limit | $2,000 |
| Primary Care Doctor Visit | In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0 to $15 Note: $0 copayment applies to Medicare covered telehealth and Medicare covered remote monitoring. The higher cost share applies to all other Medicare covered services. |
| Specialty Doctor Visit | In Network In-Network: Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $0 to $55 Prior Authorization Required for Doctor Specialty Visit Note: $0 copayment applies to Medicare covered telehealth and Medicare covered remote monitoring. The higher cost share applies to all other Medicare covered services. Out of Network Out-of-Network: Doctor Specialty Visit Services: Copayment for Medicare Covered Physician Specialist Office Visit $55 Note: $0 copayment applies to Medicare covered telehealth and Medicare covered remote monitoring. The higher cost share applies to all other Medicare covered services. Prior authorization required |
| Inpatient Hospital Care | In Network In-Network: Acute Hospital Services: $475 per day for days 1 to 5 $0 per day for days 6 to 90 Prior Authorization Required for Acute Hospital Services Note: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b. Out of Network Out-of-Network: Acute Hospital Services: $475 per day for days 1 to 5 $0 per day for days 6 to 999 Note: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b. Prior authorization required |
| Urgent Care | Copayment for Urgent Care $0 to $45 Note: $0 copayment applies to Medicare covered telehealth. The higher cost share applies to all other Medicare covered services. Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0 |
| Emergency Room Visit | Copayment for Emergency Care $110 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $0 Copayment for Worldwide Emergency Transportation $0 |
| Ambulance Transportation | In Network In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $290 Air Ambulance: Copayment for Air Ambulance Services $290 Prior Authorization Required for Air Ambulance Out of Network Out-of-Network: Ambulance Services: Copayment for Medicare Covered Ambulance Services - Ground $290 Copayment for Medicare Covered Ambulance Services - Air $290 Prior authorization required |
Health Care Services and Medical Supplies
UHC Medicare Advantage TX-0030 (Regional PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | In Network In-Network: Copayment for Medicare-covered Chiropractic Services $15 Prior Authorization Required for Chiropractic Services Out of Network Out-of-Network: Medicare Covered Chiropractic Services: Copayment for Medicare Covered Chiropractic Services $15 Prior authorization required |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In Network In-Network: Copayment for Medicare-covered Diabetic Supplies $0 Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20% Out of Network Out-of-Network: Medicare Covered Diabetic Supplies and Services: Coinsurance for Medicare Covered Diabetic Supplies 50% Coinsurance for Medicare Covered Diabetic Therapeutic Shoes or Inserts 50% |
| Durable Medical Eqipment (DME) | In Network In-Network: Coinsurance for Medicare-covered Durable Medical Equipment 20% Prior Authorization Required for Durable Medical Equipment Out of Network Out-of-Network: Medicare Covered Durable Medical Equipment Services: Coinsurance for Medicare Covered Durable Medical Equipment 50% Prior authorization required |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Diagnostic Tests and Procedures: $50 copay Lab Services: $0 copay Diagnostic Radiology Services: $250 copay X-rays: $35 copay |
| Home Health Care | In Network In-Network: Copayment for Medicare-covered Home Health Services $0 Prior Authorization Required for Home Health Services Out of Network Out-of-Network: Medicare Covered Home Health Services: Coinsurance for Medicare Covered Home Health 50% Prior authorization required |
| Mental Health Inpatient Care | In Network In-Network: Psychiatric Hospital Services: $475 per day for days 1 to 4 $0 per day for days 5 to 90 Prior Authorization Required for Psychiatric Hospital Services Benefit Details - General Note - NOTE ON INPATIENT SUBSTANCE ABUSE: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b. Out of Network Out-of-Network: Psychiatric Hospital Services: $475 per day for days 1 to 4 $0 per day for days 5 to 90 Benefit Details - General Note - NOTE ON INPATIENT SUBSTANCE ABUSE: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b. Prior authorization required |
| Mental Health Outpatient Care | In Network In-Network: Copayment for Medicare-covered Individual Sessions $0 to $25 Copayment for Medicare-covered Group Sessions $15 Out of Network Out-of-Network: Medicare Covered Mental Health Services: Copayment for Medicare Covered Individual Sessions $25 Copayment for Medicare Covered Group Sessions $15 |
| Outpatient Services / Surgery | In Network In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 to $475 Prior Authorization Required for Outpatient Hospital Services Note: $0 copayment for outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures.Note: Benefit category includes both the facility and professional component. Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per day $475 Prior Authorization Required for Outpatient Observation Services Benefit Details - General 9a2 Note - NOTE ON OBSERVATION SERVICES: Benefit category includes both the facility and professional component. Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0 to $475 Prior Authorization Required for Ambulatory Surgical Center Services Benefit Details - General 9b Note - NOTE ON ASC SERVICES: Benefit category 9b includes both the facility and professional component.Benefit Details - General 9b Note - NOTE ON COST SHARING RANGE FOR ASC Services: $0 copayment for outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures. Out of Network Out-of-Network: Medicare Covered Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 to $475 Copayment for Medicare Covered Ambulatory Surgical Center Services $0 to $475 Note: $0 copayment for outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures.Note: Benefit category includes both the facility and professional component. Prior authorization required |
| Outpatient Substance Abuse Care | In Network In-Network: Copayment for Medicare-covered Individual Sessions $0 to $25 Copayment for Medicare-covered Group Sessions $15 Prior Authorization Required for Outpatient Substance Abuse Services Note: $0 copayment applies to Medicare covered telehealth for individual sessions. The higher cost share applies to all other Medicare covered services. Out of Network Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Copayment for Medicare Covered Individual Sessions $25 Copayment for Medicare Covered Group Sessions $15 Note: $0 copayment applies to Medicare covered telehealth for individual sessions. The higher cost share applies to all other Medicare covered services. Prior authorization required |
| Podiatry Services | In Network In-Network: Copayment for Medicare-Covered Podiatry Services $45 Copayment for Routine Foot Care $45
Out of Network Out-of-Network: Medicare Covered Podiatry Services: Copayment for Medicare Covered Podiatry Services $45 Non-Medicare Covered Podiatry Services: Copayment for Non-Medicare Covered Podiatry Services $45 Prior authorization required |
| Skilled Nursing Facility Care | In Network In-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $203 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services Out of Network Out-of-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $203 per day for days 21 to 100 Prior authorization required |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In Network In-Network: Preventive Dental: Coinsurance for Office Visit 20% Prior Authorization Required for Preventive Dental Out of Network Out-of-Network: Medicare Covered Preventive Dental Services: Coinsurance for Medicare Covered Preventive Dental 20% Prior authorization required |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | Routine Eye Exam: $0 copay, 1 per year |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In Network In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $0 Copayment for Routine Hearing Exams $0
Hearing Aids: Copayment for Hearing Aids $199 to $1249
Out of Network Out-of-Network: Medicare Covered Hearing Exams Services: Copayment for Medicare Covered Hearing Exams $55 Prior authorization required |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In Network In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots:
Yearly "Wellness" visit Out of Network Out-of-Network: Medicare Covered Medicare-covered Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $0 |
Prescription Drug Costs and Coverage
The UHC Medicare Advantage TX-0030 (Regional PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $570 (excludes Tiers 1 and 2) per year.
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual Drug Deductible | $570 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $570 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $570 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
