In-network
Inpatient hospital
inpatient coinsurance is selected but its percentage is missing
● CMS 2026 plan record
UnitedHealthcare Group Medicare Advantage (PPO)
Choose and order benefitsSelections are saved only on this device.
Emergency transport
Ambulance
Ground · in-network20% coinsurance
Air · in-network20% coinsurance
Emergency services
Emergency room
20% coinsurance
Waived if admitted
Medical maximum
Maximum out-of-pocket
In-network$9,250
Combined in + out$13,900
Skilled care at home
Home health
In-network0% coinsurance
Out-of-network0% coinsurance
Monthly cost
Premium & giveback
Part C premiumNot reported
Consolidated C + DNot reported
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Primary care physician
In: 20% coinsurance · Out: 20% coinsurance
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Specialist
In: 20% coinsurance · Out: 20% coinsurance
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Preventive care
In: 20% coinsurance · Out: 0% coinsurance
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Diagnostic procedures & tests
In: 20% coinsurance · Out: 20% coinsurance
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Laboratory services
In: 0% coinsurance · Out: 20% coinsurance
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X-rays & standard imaging
In: 20% coinsurance · Out: 20% coinsurance
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MRI, CT & PET imaging
In: 20% coinsurance · Out: 20% coinsurance
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Urgent care
In: Cost share not reported · Out: Not separately reported
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Emergency room
In: 20% coinsurance · Out: Not separately reported
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Ground ambulance
In: 20% coinsurance · Out: 20% coinsurance
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Air ambulance
In: 20% coinsurance · Out: 20% coinsurance
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Outpatient hospital
In: 20% coinsurance · Out: 20% coinsurance
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Outpatient surgery / ASC
In: 20% coinsurance · Out: 20% coinsurance
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Home health
In: 0% coinsurance · Out: 0% coinsurance
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Skilled nursing facility
In: Cost share not reported · Out: Not separately reported
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Cardiac & pulmonary rehabilitation
In: 20% coinsurance · Out: 20% coinsurance
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Occupational therapy
In: 20% coinsurance · Out: 20% coinsurance
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Physical & speech therapy
In: 20% coinsurance · Out: 20% coinsurance
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Mental health services
In: 20% coinsurance · Out: 20% coinsurance
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Substance use treatment
In: 20% coinsurance · Out: 20% coinsurance
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Podiatry
In: 20% coinsurance · Out: 20% coinsurance
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Chiropractic
In: 20% coinsurance · Out: 20% coinsurance
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Dental
In: 20% coinsurance · Out: 20% coinsurance
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Vision
In: 20% coinsurance · Out: 20% coinsurance
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Hearing
In: 20% coinsurance · Out: 20% coinsurance
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Transportation
Not reported in this CMS export
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Fitness & wellness
Not reported in this CMS export
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Over-the-counter allowance
Not reported in this CMS export
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Meals
Not reported in this CMS export
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
In-network20% coinsurance
Out-of-network20% coinsurance
Specialist
In-network20% coinsurance
Out-of-network20% coinsurance
Preventive care
In-network20% coinsurance
Out-of-network0% coinsurance
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
In-network20% coinsurance
Out-of-network20% coinsurance
Laboratory services
In-network0% coinsurance
Out-of-network20% coinsurance
X-rays & standard imaging
In-network20% coinsurance
Out-of-network20% coinsurance
MRI, CT & PET imaging
In-network20% coinsurance
Out-of-network20% coinsurance
Urgent & hospital care6 benefits
Urgent care
In-networkCost share not reported
Out-of-networkNot separately reported
Emergency room
In-network20% coinsurance
Out-of-networkNot separately reported
Ground ambulance
In-network20% coinsurance
Out-of-network20% coinsurance
Air ambulance
In-network20% coinsurance
Out-of-network20% coinsurance
Outpatient hospital
In-network20% coinsurance
Out-of-network20% coinsurance
Outpatient surgery / ASC
In-network20% coinsurance
Out-of-network20% coinsurance
Recovery & therapy5 benefits
Home health
In-network0% coinsurance
Out-of-network0% coinsurance
Skilled nursing facility
In-networkCost share not reported
Out-of-networkNot separately reported
Cardiac & pulmonary rehabilitation
In-network20% coinsurance
Out-of-network20% coinsurance
Occupational therapy
In-network20% coinsurance
Out-of-network20% coinsurance
Physical & speech therapy
In-network20% coinsurance
Out-of-network20% coinsurance
Behavioral health2 benefits
Mental health services
In-network20% coinsurance
Out-of-network20% coinsurance
Substance use treatment
In-network20% coinsurance
Out-of-network20% coinsurance
Specialty care2 benefits
Podiatry
In-network20% coinsurance
Out-of-network20% coinsurance
Chiropractic
In-network20% coinsurance
Out-of-network20% coinsurance
Supplemental benefits7 benefits
Dental
In-network20% coinsurance
Out-of-network20% coinsurance
Vision
In-network20% coinsurance
Out-of-network20% coinsurance
Hearing
In-network20% coinsurance
Out-of-network20% coinsurance
Transportation
Not reported in this CMS exportNot reported in this CMS export
Fitness & wellness
Not reported in this CMS exportNot reported in this CMS export
Over-the-counter allowance
Not reported in this CMS exportNot reported in this CMS export
Meals
Not reported in this CMS exportNot reported in this CMS export
Plan costs & rulesCoverage overview
Premium & Part B giveback
Part C premium not reported · Part B giveback not separately reported
Maximum out-of-pocket (MOOP)
In-network$9,250
Combined in + out$13,900
Medical deductibles
In-networkNot reported
Out-of-networkNot reported
Network & referrals
Local PPO · Referrals: Not required · Out-of-network coverage: Yes
Prescription drugs0 tiers
Part D deductible
This plan is not present in the public CMS Landscape release
Using this plan
Understand H2001-867-000
Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.
Plan at a glance
A quick read on this plan
UnitedHealthcare Group Medicare Advantage (PPO) is a 2026 Local PPO offered by UnitedHealthcare in Nationwide. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals.
Common benefit costs
What you may pay
These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.
Routine care
- Primary care physician
- 20% coinsurance
- Specialist
- 20% coinsurance
- Laboratory services
- 0% coinsurance
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- 20% coinsurance
- MRI, CT & PET imaging
- 20% coinsurance
- Outpatient hospital
- 20% coinsurance
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- 20% coinsurance
Actual costs depend on the care received and plan rules.
Helpful context
Terms worth knowing
Maximum out-of-pocket (MOOP)
This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.
Availability
Who can enroll
- Service area
- Nationwide (AK, AL, AR, AS, AZ, CA, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MP, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VI, VT, WA, WI, WV, WY)
- Plan type
- Local PPO
- Contract / plan
- H2001-867
- Coverage year
- 2026
Enrollment is limited to people eligible through the sponsoring employer or group. Confirm eligibility and the exact service area with the plan before enrolling.
Supplemental coverage
Extra benefits reported
Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.
Dental20% coinsurance
Vision20% coinsurance
Hearing20% coinsurance
Plan-specific answers
Frequently asked questions
Where is H2001-867-000 available?
UnitedHealthcare Group Medicare Advantage (PPO) is listed for Nationwide (AK, AL, AR, AS, AZ, CA, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MP, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VI, VT, WA, WI, WV, WY). Enrollment is limited to people eligible through the sponsoring employer or group.
What is the in-network maximum out-of-pocket limit for H2001-867-000?
The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $9,250. Prescription drug spending generally does not count toward this medical limit.
What does an emergency room visit cost on H2001-867-000?
The plan record lists 20% coinsurance, waived when an admission meets the plan's stated timing rule.
Does H2001-867-000 report extra benefits?
Yes. CMS reports dental, vision, hearing. See the detailed benefit rows and official plan documents for limits and conditions.
Source trail
Official CMS, Contract Year 2026
Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.
Plan context
Where H2001-867-000 fits
- Full CMS plan ID
H2001-867-000- Contract
H2001- Base plan code
H2001-867- Segment
000- Carrier
- UnitedHealthcare
- Plan type
- Local PPO
- Service area
- Nationwide (AK, AL, AR, AS, AZ, CA, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MP, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VI, VT, WA, WI, WV, WY)
45 additional service-area states listed in the CMS record.
County/service-area foundation
CMS service-area entries
These named entries come from a CMS contract-level service-area file. They describe the contract's published geography and must not be treated as proof that every segment has identical county-level rules.
- Aleutians East, AK · employer/group only
- Aleutians West, AK · employer/group only
- Anchorage, AK · employer/group only
- Bethel, AK · employer/group only
- Bristol Bay, AK · employer/group only
- Chugach, AK · employer/group only
- Copper River, AK · employer/group only
- Denali, AK · employer/group only
- Dillingham, AK · employer/group only
- Fairbanks North Star, AK · employer/group only
- Haines, AK · employer/group only
- Hoonah-Angoon, AK · employer/group only
3336 additional service-area entries are retained in the data record.
About this code
What H2001-867-000 identifies
H2001-867-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H2001-867, H2001 867, or the compact full CMS ID H2001867000 refer to this plan or its base plan code.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.