In-network
Inpatient hospital
Days 1–3 $685 / day
Days 4–90 $0 / day
Total of listed copays · 3 charged days $2,055
● CMS 2026 plan record
AARP Medicare Advantage from UHC HI-0004 (PPO)
Choose and order benefitsSelections are saved only on this device.
Emergency transport
Ambulance
Ground · in-network$275 copay
Air · in-network$275 copay
Emergency services
Emergency room
$130 copay
Waived if admitted within 24 hours
Medical maximum
Maximum out-of-pocket
In-network$6,700
Combined in + out$10,100
Skilled care at home
Home health
In-network$0 copay
Out-of-network50% coinsurance
Monthly cost
Premium & giveback
Part C premium$0 / month
Consolidated C + D$54 / month
Quick view
Primary care physician
In: $0 copay · Out: $40 copay
Quick view
Specialist
In: $0–$50 copay · Out: $95 copay
Quick view
Preventive care
In: $0 copay · Out: 0%–40% coinsurance
Quick view
Diagnostic procedures & tests
In: $5 copay · Out: 40% coinsurance
Quick view
Laboratory services
In: $0 copay · Out: $0 copay
Quick view
X-rays & standard imaging
In: $0–$230 copay · Out: 40% coinsurance
Quick view
MRI, CT & PET imaging
In: $30 copay · Out: 40% coinsurance
Quick view
Urgent care
In: Cost share not reported · Out: Not separately reported
Quick view
Emergency room
In: $130 copay · Out: Not separately reported
Quick view
Ground ambulance
In: $275 copay · Out: $275 copay
Quick view
Air ambulance
In: $275 copay · Out: $275 copay
Quick view
Outpatient hospital
In: $0–$685 copay · Out: 40% coinsurance
Quick view
Outpatient surgery / ASC
In: $0–$635 copay · Out: 40% coinsurance
Quick view
Home health
In: $0 copay · Out: 50% coinsurance
Quick view
Skilled nursing facility
In: Cost share not reported · Out: Not separately reported
Quick view
Cardiac & pulmonary rehabilitation
In: $0 copay · Out: 40% coinsurance
Quick view
Occupational therapy
In: $40 copay · Out: $95 copay
Quick view
Physical & speech therapy
In: $50 copay · Out: $95 copay
Quick view
Mental health services
In: $55 copay · Out: $75 copay
Quick view
Substance use treatment
In: $55 copay · Out: $75 copay
Quick view
Podiatry
In: $35 copay · Out: $95 copay
Quick view
Chiropractic
In: $15 copay · Out: $95 copay
Quick view
Dental
In: 20% coinsurance · Out: 40% coinsurance
Quick view
Vision
In: $0 copay · Out: $95 copay
Quick view
Hearing
In: $0 copay · Out: $95 copay
Quick view
Transportation
Not reported in this CMS export
Quick view
Fitness & wellness
In: $0 copay · Out: $0 copay
Quick view
Over-the-counter allowance
In: $0 copay · Out: $0 copay
Quick view
Meals
Not reported in this CMS export
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
In-network$0 copay
Out-of-network$40 copay
Specialist
In-network$0–$50 copay
Out-of-network$95 copay
Preventive care
In-network$0 copay
Out-of-network0%–40% coinsurance
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
In-network$5 copay
Out-of-network40% coinsurance
Laboratory services
In-network$0 copay
Out-of-network$0 copay
X-rays & standard imaging
In-network$0–$230 copay
Out-of-network40% coinsurance
MRI, CT & PET imaging
In-network$30 copay
Out-of-network40% coinsurance
Urgent & hospital care6 benefits
Urgent care
In-networkCost share not reported
Out-of-networkNot separately reported
Emergency room
In-network$130 copay
Out-of-networkNot separately reported
Ground ambulance
In-network$275 copay
Out-of-network$275 copay
Air ambulance
In-network$275 copay
Out-of-network$275 copay
Outpatient hospital
In-network$0–$685 copay
Out-of-network40% coinsurance
Outpatient surgery / ASC
In-network$0–$635 copay
Out-of-network40% coinsurance
Recovery & therapy5 benefits
Home health
In-network$0 copay
Out-of-network50% coinsurance
Skilled nursing facility
In-networkCost share not reported
Out-of-networkNot separately reported
Cardiac & pulmonary rehabilitation
In-network$0 copay
Out-of-network40% coinsurance
Occupational therapy
In-network$40 copay
Out-of-network$95 copay
Physical & speech therapy
In-network$50 copay
Out-of-network$95 copay
Behavioral health2 benefits
Mental health services
In-network$55 copay
Out-of-network$75 copay
Substance use treatment
In-network$55 copay
Out-of-network$75 copay
Specialty care2 benefits
Podiatry
In-network$35 copay
Out-of-network$95 copay
Chiropractic
In-network$15 copay
Out-of-network$95 copay
Supplemental benefits7 benefits
Dental
In-network20% coinsurance
Out-of-network40% coinsurance
Vision
In-network$0 copay
Out-of-network$95 copay
Hearing
In-network$0 copay
Out-of-network$95 copay
Transportation
Not reported in this CMS exportNot reported in this CMS export
Fitness & wellness
In-network$0 copay
Out-of-network$0 copay
Over-the-counter allowance
In-network$0 copay
Out-of-network$0 copay
Meals
Not reported in this CMS exportNot reported in this CMS export
Plan costs & rulesCoverage overview
Premium & Part B giveback
$0 Part C premium / month · Part B giveback not separately reported
Maximum out-of-pocket (MOOP)
In-network$6,700
Combined in + out$10,100
Medical deductibles
In-networkNot reported
Out-of-networkNot reported
Network & referrals
Local PPO · Referrals: Not required · Out-of-network coverage: Yes
Prescription drugs5 tiers
Part D deductible
Not reported
Drug tier 1
$0 retail copay · 30-day supply
Drug tier 2
$12 retail copay · 30-day supply
Drug tier 3
21% retail coinsurance · 30-day supply
Drug tier 4
28% retail coinsurance · 30-day supply
Drug tier 5
26% retail coinsurance · 30-day supply
Using this plan
Understand H2406-093-000
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
AARP Medicare Advantage from UHC HI-0004 (PPO) is a 2026 Local PPO offered by UnitedHealthcare in Hawaii County. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals. Its listed inpatient copay stages total $2,055 across 3 charged days.
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
- $0 copay
- Specialist
- $0–$50 copay
- Laboratory services
- $0 copay
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- $5 copay
- MRI, CT & PET imaging
- $30 copay
- Outpatient hospital
- $0–$685 copay
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- $130 copay
- Listed inpatient stages
- $2,055 total
3 charged inpatient days are included in the calculated total. 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
- Hawaii County (HI)
- Plan type
- Local PPO
- Contract / plan
- H2406-093
- Coverage year
- 2026
Enrollment generally requires Medicare eligibility and residence in the plan's service area. 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
Vision$0 copay
Hearing$0 copay
Over-the-counter allowance$0 copay
Fitness & wellness$0 copay
Plan-specific answers
Frequently asked questions
Where is H2406-093-000 available?
AARP Medicare Advantage from UHC HI-0004 (PPO) is listed for Hawaii County (HI). Enrollment generally requires Medicare eligibility and residence in the plan's service area.
What is the in-network maximum out-of-pocket limit for H2406-093-000?
The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $6,700. Prescription drug spending generally does not count toward this medical limit.
What is the monthly plan premium for H2406-093-000?
The listed consolidated Part C and Part D premium is $54 per month. This does not replace the standard Medicare Part B premium.
What does an emergency room visit cost on H2406-093-000?
The plan record lists $130 copay, waived when an admission meets the plan's stated timing rule.
Does H2406-093-000 report extra benefits?
Yes. CMS reports dental, vision, hearing, over-the-counter allowance, fitness & wellness. See the detailed benefit rows and official plan documents for limits and conditions.
Carrier-hosted source material
Official plan documents
Matched to H2406-093-000 for 2026 using the carrier's official document system.
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 H2406-093-000 fits
- Full CMS plan ID
H2406-093-000- Contract
H2406- Base plan code
H2406-093- Segment
000- Carrier
- UnitedHealthcare
- Plan type
- Local PPO
- Service area
- Hawaii County (HI)
County/service-area foundation
CMS service-area entries
Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.
- Hawaii, HI
About this code
What H2406-093-000 identifies
H2406-093-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H2406-093, H2406 093, or the compact full CMS ID H2406093000 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.