UHC Medicare Advantage GA-2 (PPO)

Available to residents of Clinch County, GA for 2026. Contract H1889, plan 013, segment 0.

Renewed, service area reduced for 2026. CMS carries this plan forward from 2025.

Plan details

Monthly premium (Part C + D)	$0.00
— medical (Part C) part	$0.00
— drug (Part D) part	$0.00?
Monthly premium with full Extra Help (LIS)	$0.00?
Part B premium reduction (giveback)	None
In-network out-of-pocket maximum	$9,250.00?
In- and out-of-network out-of-pocket maximum	$13,900.00
Drug deductible	$600.00Tier 1 and 2 exempt
Drug out-of-pocket threshold	$2,100.00
Plan type	PPO?
Contract / plan	H1889-013-0
Offered by	UnitedHealthcare
Parent organization	UnitedHealth Group, Inc.
Formulary drugs	3,609
Formulary exception tier	4?
Pharmacy search	UHC.com/Medicare
Member services	(800)555-5757TTY 711

CMS star ratings

Overall: 4 out of 5 stars for Overall
Health plan (Part C): 4 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 4 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H1889 shares this rating.

Plan health benefits

Service	In-network	Out-of-network?
Doctor visits
Primary care doctor	$0 copay	$30 copay
Specialist	$0–$55 copay(authorization required)	$85 copay
Other health care professional	$0–$55 copay(authorization required)	$30–$85 copay
Additional telehealth services	$0 copay	—
Preventive care
Medicare-covered preventive services	$0 copay	0%–40% coinsurance
Annual physical exam	$0 copay	40% coinsurance
Kidney disease education	$0 copay	40% coinsurance
Glaucoma screening	$0 copay	$85 copay
Diabetes self-management training	$0 copay	40% coinsurance
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	$50 copay(authorization required)	$75 copay
Lab services	$0 copay(authorization required)	$0 copay
Diagnostic radiology (e.g. MRI, CT)	$0–$260 copay(authorization required)	$360 copay
Therapeutic radiology	$60 copay(authorization required)	40% coinsurance
Outpatient x-rays	$25 copay(authorization required)	$50 copay
Emergency and urgent care
Emergency room	$115 copay	—
Urgent care	$0–$40 copay	—
Worldwide emergency coverage	$0 copay	—
Worldwide urgent care	$0 copay	—
Worldwide emergency transportation	$0 copay	—
Hospital care
Inpatient hospital stay	$530 per day for days 1–3; $0 per day for days 4–90; $0 per day for days 91–999 (additional days)(authorization required)	50% coinsurance per stay
Outpatient hospital services	$0–$530 copay(authorization required)	50% coinsurance
Outpatient observation	$530 copay(authorization required)	50% coinsurance
Ambulatory surgical center	$0–$480 copay(authorization required)	50% coinsurance
Outpatient blood services	$0 copay(authorization required)	$0 copay
Skilled nursing and home health
Skilled nursing facility	$0 per day for days 1–20; $218 per day for days 21–100(authorization required)	$250 per day for days 1–100
Home health care	$0 copay(authorization required)	50% coinsurance
Kidney dialysis	20% coinsurance(authorization required)	20% coinsurance
Rehabilitation
Occupational therapy	$35 copay(authorization required)	$85 copay
Physical therapy and speech-language therapy	$55 copay(authorization required)	$85 copay
Cardiac rehabilitation	$0 copay(authorization required)	$85 copay
Pulmonary rehabilitation	$15 copay(authorization required)	$85 copay
Mental health and substance use
Inpatient psychiatric hospital stay	$530 per day for days 1–3; $0 per day for days 4–90(authorization required)	50% coinsurance per stay
Outpatient mental health, individual session	$0–$25 copay(authorization required)	$40 copay
Outpatient mental health, group session	$15 copay(authorization required)	$30 copay
Psychiatrist, individual session	$0–$25 copay(authorization required)	$40 copay
Psychiatrist, group session	$15 copay(authorization required)	$30 copay
Partial hospitalization	$55 copay(authorization required)	$75 copay
Intensive outpatient program	$55 copay(authorization required)	$75 copay
Outpatient substance use, individual session	$0–$25 copay(authorization required)	$40 copay
Outpatient substance use, group session	$15 copay(authorization required)	$30 copay
Opioid treatment program	$0 copay(authorization required)	$0 copay
Ambulance and transportation
Ground ambulance	$290 copay(authorization required)	$290 copay
Air ambulance	$290 copay(authorization required)	$290 copay
Transportation to plan-approved locations	Not covered	—
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	20% coinsurance(authorization required)	50% coinsurance
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)	50% coinsurance
Medical supplies	20% coinsurance(authorization required)	50% coinsurance
Diabetes supplies	$0 copay(authorization required)	50% coinsurance
Diabetic therapeutic shoes or inserts	20% coinsurance(authorization required)	50% coinsurance
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	$15 copay(authorization required)	$85 copay
Routine chiropractic care	Not covered	—
Acupuncture	Not covered	—
Foot exams and treatment (Medicare-covered)	$45 copay(authorization required)	$85 copay
Routine foot care	$45 copay(authorization required, limits apply)	$85 copay
Dental?
Medicare-covered dental services	20% coinsurance(authorization required)	40% coinsurance
Oral exams	$0 copay(limits apply)	$0 copay
Cleanings	$0 copay(limits apply)	$0 copay
Fluoride treatment	$0 copay(limits apply)	$0 copay
Dental x-rays	$0 copay(limits apply)	$0 copay
Other diagnostic dental services	Optional supplemental benefit (extra premium)	—
Other preventive dental services	$0 copay(limits apply)	$0 copay
Restorative services (fillings, crowns)	Not covered	—
Endodontics (root canals)	Not covered	—
Periodontics (gum disease)	Not covered	—
Dentures and other removable prosthodontics	Not covered	—
Maxillofacial prosthetics	Not covered	—
Implants	Not covered	—
Bridges and other fixed prosthodontics	Not covered	—
Oral and maxillofacial surgery	Not covered	—
Orthodontics	Not covered	—
Adjunctive general services	Not covered	—
Vision?
Eye exam (Medicare-covered)	$0 copay(authorization required)	$85 copay
Routine eye exam	$0 copay(authorization required, limits apply)	$85 copay
Eyewear after cataract surgery (Medicare-covered)	$0 copay(limits apply)	$85 copay
Eyewear plan limit	$150 plan limit every two years	—
Contact lenses	$0 copay(limits apply)	$0 copay
Eyeglasses (frames and lenses)	Not covered	—
Eyeglass lenses	$0–$153 copay(limits apply)	$0–$153 copay
Eyeglass frames	$0 copay(limits apply)	$0 copay
Eyewear upgrades	Not covered	—
Hearing?
Hearing exam (Medicare-covered)	$0 copay(authorization required)	$85 copay
Routine hearing exam	$0 copay(authorization required, limits apply)	$85 copay
Hearing aid fitting and evaluation	Not covered	—
Hearing aids (all types)	$199–$1,249 copay(authorization required, limits apply)	$199–$1,249 copay
Hearing aids, inner ear	Not covered	—
Hearing aids, outer ear	Not covered	—
Hearing aids, over the ear	Not covered	—
Medicare Part B drugs
Part B insulin	0%–20% coinsurance(authorization required, step therapy may apply)	40% coinsurance
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required, step therapy may apply)	40% coinsurance
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)	0%–40% coinsurance
Other extra benefits?
Over-the-counter (OTC) allowance	Covered (allowance not stated)	—
Meals after a hospital stay or for a chronic condition	$0 copay(authorization required)	$0 copay
Fitness benefit	$0 copay	$0 copay
Health education	Not covered	—
Nutritional / dietary benefit	Not covered	—
Extra smoking and tobacco cessation counseling	Not covered	—
Enhanced disease management	Not covered	—
Telemonitoring	Not covered	—
Remote access technologies (web/phone, nurse line)	Not covered	—
Home and bathroom safety devices	$0 copay	$0 copay
Counseling services	Not covered	—
In-home safety assessment	Not covered	—
Personal emergency response system (PERS)	Not covered	—
Medical nutrition therapy	Not covered	—
Post-discharge in-home medication reconciliation	Not covered	—
Re-admission prevention	Not covered	—
Wigs for hair loss from chemotherapy	Not covered	—
Weight management programs	Not covered	—
Alternative therapies	Not covered	—
Therapeutic massage	Not covered	—
Adult day health services	Not covered	—
Home-based palliative care	Not covered	—
In-home support services	Not covered	—
Support for caregivers	Not covered	—

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.

Drug tiers — preferred pharmacy, initial coverage

Tier	Cost-sharing
Tier 1	$0.00
Tier 2	$14.00
Tier 3	18%
Tier 4	30%
Tier 5	26%

Rx cost-sharing by coverage phase

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial deductible phase
Tier 1: Preferred Generic	$0.00	$0.00	n/a	$0.00	$0.00	$0.00
Tier 2: Generic	$14.00	$14.00	n/a	$42.00	$42.00	$0.00
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	n/a	$0.00	$0.00	$0.00
Tier 2: Generic	$14.00	$14.00	n/a	$42.00	$42.00	$0.00
Tier 3: Preferred Brand	18%	18%	n/a	18%	18%	18%
Tier 4: Non-Preferred Drug	30%	30%	30%	n/a	n/a	n/a
Tier 5: Specialty Tier	26%	26%	26%	n/a	n/a	n/a
Catastrophic coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 3: Preferred Brand	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 4: Non-Preferred Drug	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 5: Specialty Tier	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00

Also available in 145 other GA counties

Benefits in plain text

UHC Medicare Advantage GA-2 (PPO) (H1889-013-0) is a 2026 PPO Medicare Advantage plan offered by UnitedHealthcare, available to residents of Clinch County, GA.

The monthly premium is $0.00 (Part C and Part D together).

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.

Its in-network out-of-pocket maximum is $9,250.00.

The combined in- and out-of-network out-of-pocket maximum is $13,900.00.

The drug deductible is $600.00. Tier 1 and 2 exempt.

The plan's formulary lists 3,609 drugs.

At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $14.00; tier 3: 18%; tier 4: 30%; tier 5: 26%.

CMS gives the plan's contract (H1889) an overall rating of 4 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.