AARP Medicare Advantage from UHC NH-0004 (PPO)

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. · 2027 plan year

Plan ID H8768-061-000

Local PPO★ 4 CMS Stars
MOOP (in-network)
$8,900
MOOP (combined)
$14,800
Monthly premium
$59/mo
Part C $0 + Part D $59, before Extra Help
Prescription drugs
Included

This plan in 2026

Plan information

Contract / Plan / Segment
H8768-061-000
Medical deductible
$1,000
Part D premium
$59/mo (part of the monthly premium above)Before Extra Help, which can lower or remove it for people with limited income.
Part D deductible
$685/yr
Also owed
Your Medicare Part B premium, paid separately

More CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. plans in NH

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — Additional Days (Acute)No charge
Inpatient Hospital — Psychiatric$550/day for days 1–3, $0 after
Inpatient Hospital — Acute$550/day for days 1–4, $0 after

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual Sessions$0-$25
Mental Health — Group Sessions$15

Other

BenefitIn-network
Skilled Nursing Facility (SNF)$0/day for days 1–20, $221/day for days 21–100
Cardiac Rehabilitation — Additional SessionsNo charge
Intensive Cardiac Rehabilitation — Additional SessionsNo charge
Pulmonary Rehabilitation — Additional SessionsNo charge
Supervised Exercise Therapy (SET)No charge
Emergency Services$115
Urgently Needed Services$0-$40
Partial Hospitalization Program$55
Intensive Outpatient Program (IOP)$55
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Chiropractic Services$15
Occupational Therapy Services$35
Physician Specialist Services$0-$60
Podiatry Services$45
Podiatry Services$45
Other Health Care Professional Services$0-$60
Psychiatric ServicesSee plan details
Psychiatric Services — Individual Sessions$0-$25
Psychiatric Services — Group Sessions$15
X-Ray Services$20
Physical Therapy & Speech-Language Pathology$55
Opioid Treatment Program ServicesNo charge
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & Tests$5
Laboratory ServicesNo charge
Radiological ServicesSee plan details
Diagnostic Radiology$0-$320
Therapeutic Radiology$60
Outpatient Hospital Services$0-$550
Hospital Observation Services$550/day
Ambulatory Surgical Center (ASC)$0-$500
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual Sessions$0-$25
Substance Abuse — Group Sessions$15
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground Ambulance$330
Air Ambulance$330
Durable Medical Equipment (DME)20% coinsurance
Prosthetics & OrthoticsSee plan details
Prosthetic Devices20% coinsurance
Medical Supplies20% coinsurance
Diabetic Supplies & ServicesSee plan details
Diabetic SuppliesNo charge
Diabetic Therapeutic Shoes & Inserts20% coinsurance
Diabetic MonitorsNo charge
Dialysis Services20% coinsurance
Medicare-Covered Preventive ServicesSee plan details
Annual Physical ExamNo charge
Kidney Disease Education ServicesNo charge
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)0%-20% coinsurance (max $35)
Dental — Medicare-Covered Services20% coinsurance
Vision — Eye ExamsNo charge
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Dental — X-RaysNo charge
Dental — Prophylaxis (Cleaning)No charge
Dental — Fluoride TreatmentNo charge
Dental — Other Preventive ServicesNo charge
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — EyewearNo charge
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Hearing — ExamsNo charge
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Cardiac & Pulmonary RehabilitationSee plan details
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)No charge

Service area

  • NH: 4 counties

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