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Essential Health Insurance

AARP Personal Health Insurance - Highlights

 
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Early retirement? Between jobs? Self-employed? Whatever stage your life is in, an AARP Personal Health Insurance Plan offers the coverage you need and the flexibility you want. Designed to meet the needs of people 50-64, the AARP Personal Health Insurance Plan, underwritten by United HealthCare Insurance Company, is coverage you can trust.

More Choice in Deductibles
With the Comprehensive Plan, you have three choices of deductibles, allowing you to choose a plan that best fits your needs and budget. Choose between deductible levels of $1000, $2500, and $5000. Or, choose the Limited Plan, with a $2000 deductible and less coverage.

It's an extensive network, so you can use the doctors and hospitals you prefer- though you will save money if your providers are in the network. To find out if your doctor and favorite hospitals are in the network, click here.

It's made so more AARP members can qualify-No lab tests or doctor's exams are required to apply. To learn more, and discover other advantages of the plans, click here.

It offers special services and online tools that empower you with more control over your own health care. To find out more, click here.

It's a more personal, patient-friendly approach to health care. To find out more, click here.

It offers Comprehensive and Limited Coverage plans to fit different needs and budgets. To find out more, click here.

AARP Personal Health Insurance Benefit Highlights
  Comprehensive Plan Limited Coverage Plan
  Network Non-
Network+
Network Non-
Network+
Annual deductible $1000
$2500
$5000
$2000
$5000
$7500
$2000 $3000
Annual out-of-pocket maximum (coinsurance only, does not include prescription copays) 100% benefit after paying $2,500 in coinsurance (in- and out-of network combined) 80% benefit after paying $2,500 (in NC 100% benefit after paying $5,000) in coinsurance (in- and out-of network combined) 100% benefit after paying $2,500 in coinsurance (in- and out-of network combined) 80% benefit after paying $2,500 (in NC 100% benefit after paying $5,000) in coinsurance (in- and out-of network combined)
Lifetime Maximum $5 million combined lifetime maximum $5 million combined lifetime maximum
Benefits
  • Generic prescription drugs

  • Brand prescription drugs


$10 copay

50% coinsurance


50% coinsurance

50% coinsurance

$10 copay after $5,000 deductible

50% after $5,000 deductible


50% after $5,000 deductible

50% after $5,000 deductible
  • Inpatient hospital
  • Outpatient surgery
Plan pays 80% after deductible Plan pays 60% after deductible Plan pays 80% after deductible Plan pays 60% after deductible
  • Radiology and lab tests*
Plan pays 80% after deductible Plan pays 60% after deductible Plan pays 80% after deductible for preoperative tests with covered surgery Plan pays 60% after deductible for preoperative tests with covered surgery
  • Skilled nursing facility/ Inpatient rehab facilities*
  • Durable medical equipment*
  • IV therapy
  • Hospice*
  • Prosthetic devices*
  • Reconstructive procedures (non-cosmetic)
Plan pays 80% after deductible Plan pays 60% after deductible Plan pays 80% after deductible Plan pays 60% after deductible
  • Office visits to a primary care doctor or specialist
  • Preventive care
  • Behavioral health/substance abuse*
  • Home health*
  • Rehab services*
  • Urgent care center services
Plan pays 80% after deductible Plan pays 60% after deductible Not covered Not covered
  • Emergency care
  • Ambulance (emer. only)
Plan pays 80% after deductible Plan pays 80% after deductible Plan pays 80% after deductible Plan pays 80% after deductible
  • Transplant services*
Plan pays 80% after deductible Not covered (unless state mandated) Plan pays 80% after deductible Not covered (unless state mandated)

Network Benefits: In general, 80% of your costs are covered, so you pay less. You also pay less because network providers accept lower negotiated rates. And you don't need to file claims -your insurance pays the providers directly.
Non-Network Benefits: In general, only 60% of your costs are covered, so you pay more. You are responsible for paying your provider for any difference between the amount the provider bills and the "eligible expense" (the standard amount that is usual and customary for a medical procedure). In addition, non-network providers sometimes want payment up front. If that is the case, you'll have to file a claim to get reimbursed.

+ Benefits based on Eligible Expenses.
* Certain exclusions and limitations apply. See Definitions and Exclusions  for more details. This summary of benefits is intended to highlight benefits and should not be relied upon to fully determine coverage. This plan may not fully cover all of your health care expenses. Actual benefits are subject to the terms, conditions, limitations and exclusions of the Group Policy and Certificate of Coverage. Review your Certificate of Coverage for a full description of your plan.

 

 

Deductibles: this is the amount you have to pay before your insurance coverage begins paying benefits
Coinsurance: this is a cost you pay after you've met your deductible, usually a percentage of medical expenses...for example, this plan pays 80% of most medical costs when you use network providers.
Copays: these are also costs you pay after you've met your deductible, but copays are usually fixed costs...like the $10 copay for generic drugs purchased in-network that is required by this plan.
Out-of-pocket maximums: after you meet your deductible, this is the most in coinsurance you can pay in a single year (the only exceptions to this are the unlimited copays for prescriptions or if you exceed your maximum benefits)
Maximum benefits: this is the most you can receive in health benefits while you're on the plan