UHC Medicare Advantage Patriot No Rx GS-MA01 (PPO) Medicare Advantage Plan R2604-005 • 2027
CMS Rating:
(3.5 out of 5 stars*)
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 1,065 beneficiaries
Last update:
UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) Introduction
CMS Plan ID R2604-005 identifies UHC Medicare Advantage Patriot No Rx GS-MA01, a Medicare Advantage Regional PPO plan offered by UnitedHealthcare. The plan uses a Preferred Provider Organization (PPO) provider network and comes without prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket.
Plan Benefits
UHC Medicare Advantage Patriot No Rx GS-MA01 has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan R2604-005.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Specialist | In-network: $0-$60 copay Out-of-network: $60 copay |
In-network: $0-$55 copay Out-of-network: $55 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay |
| Telehealth benefit | Not covered | In-network: $0 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: 90% coinsurance |
In-network: $0 copay Out-of-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$270 copay Out-of-network: $0-$270 copay |
In-network: $0-$260 copay Out-of-network: $0-$260 copay |
| Lab services | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Outpatient x-rays | In-network: $30 copay Out-of-network: $30 copay |
In-network: $30 copay Out-of-network: $30 copay |
| Diagnostic tests and procedures | In-network: $40 copay Out-of-network: $40 copay |
In-network: $50 copay Out-of-network: $50 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $115 copay | $115 copay |
| Worldwide emergency care | Coming soon | $0 copay |
| Urgent care | $0-$40 copay | $0-$40 copay |
| Inpatient hospital care | In-network: Tier 1 $540 per day for days 1-4 $0 per day for days 5-90 $0 per stay Out-of-network: $540 per day for days 1-4 $0 per day for days 5-999 $0 per stay |
In-network: Tier 1 $470 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: $470 per day for days 1-5 $0 per day for days 6-999 $0 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 Out-of-network: $250 per day for days 1-100 $0 per stay |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: $250 per day for days 1-100 $0 per stay |
| Ground ambulance | In-network: $350 copay Out-of-network: $350 copay |
In-network: $290 copay Out-of-network: $290 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0-$25 copay Out-of-network: $25 copay |
In-network: $0-$25 copay Out-of-network: $25 copay |
| Outpatient group therapy | In-network: $15 copay Out-of-network: $15 copay |
In-network: $15 copay Out-of-network: $15 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $540 per day for days 1-4 $0 per day for days 5-90 $0 per stay Out-of-network: $540 per day for days 1-4 $0 per day for days 5-999 $0 per stay |
In-network: Tier 1 $470 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: $470 per day for days 1-5 $0 per day for days 6-999 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $35 copay Out-of-network: $35 copay |
In-network: $55 copay Out-of-network: $55 copay |
| Occupational therapy | In-network: $35 copay Out-of-network: $35 copay |
In-network: $35 copay Out-of-network: $35 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
In-network: 20% coinsurance Out-of-network: 50% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
In-network: 20% coinsurance Out-of-network: 50% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Dental x-rays | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Cleaning | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Periodontics | Not covered | Not covered |
| Endodontics | Not covered | Not covered |
| Restorative services | Not covered | Not covered |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | Not covered | Not covered |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Contact lenses | In-network: $0 copay Out-of-network: 90% coinsurance |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglass frames only | Not covered | In-network: $0 copay Out-of-network: $0 copay |
| Eyeglass lenses only | Not covered | In-network: $0-$153 copay Out-of-network: $0-$153 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: 90% coinsurance |
Not covered |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: $60 copay |
In-network: $0 copay Out-of-network: $55 copay |
| Fitting/evaluation | Not covered | Not covered |
| Prescription hearing aids | In-network: $0 copay Out-of-network: 90% coinsurance |
In-network: $199-$1249 copay Out-of-network: $199-$1249 copay |
| OTC hearing aids | Not covered | In-network: $199-$829 copay Out-of-network: $199-$829 copay |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | In-network: $0 copay Out-of-network: 90% coinsurance |
In-network: $0 copay Out-of-network: $0 copay |
Certain preventive services are covered 100% by UHC Medicare Advantage Patriot No Rx GS-MA01 as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Performance Ratings (Contract ID: R2604)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for UnitedHealthcare
- Website
- UnitedHealthcare Plan Page
- Providers
- UnitedHealthcare Providers Page
- Formulary
- UnitedHealthcare Formulary Page
- Pharmacy
- UnitedHealthcare Pharmacy Page
- New Member Health Plan Help
- (800)555-5757
- New Member Health Plan TTY
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
UHC Medicare Advantage Patriot No Rx GS-MA01 (R2604-005-0) is available in the following locations:
Georgia Counties Served
- Appling
- Atkinson
- Bacon
- Baker
- Baldwin
- Banks
- Barrow
- Bartow
- Ben Hill
- Berrien
- Bibb
- Bleckley
- Brantley
- Brooks
- Bryan
- Bulloch
- Burke
- Butts
- Calhoun
- Camden
- Candler
- Carroll
- Catoosa
- Charlton
- Chatham
- Chattahoochee
- Chattooga
- Cherokee
- Clarke
- Clay
- Clayton
- Clinch
- Cobb
- Coffee
- Colquitt
- Columbia
- Cook
- Coweta
- Crawford
- Crisp
- Dade
- Dawson
- Decatur
- Dekalb
- Dodge
- Dooly
- Dougherty
- Douglas
- Early
- Echols
- Effingham
- Elbert
- Emanuel
- Evans
- Fannin
- Fayette
- Floyd
- Forsyth
- Franklin
- Fulton
- Gilmer
- Glascock
- Glynn
- Gordon
- Grady
- Greene
- Gwinnett
- Habersham
- Hall
- Hancock
- Haralson
- Harris
- Hart
- Heard
- Henry
- Houston
- Irwin
- Jackson
- Jasper
- Jeff Davis
- Jefferson
- Jenkins
- Johnson
- Jones
- Lamar
- Lanier
- Laurens
- Lee
- Liberty
- Lincoln
- Long
- Lowndes
- Lumpkin
- Macon
- Madison
- Marion
- Mcduffie
- Mcintosh
- Meriwether
- Miller
- Mitchell
- Monroe
- Montgomery
- Morgan
- Murray
- Muscogee
- Newton
- Oconee
- Oglethorpe
- Paulding
- Peach
- Pickens
- Pierce
- Pike
- Polk
- Pulaski
- Putnam
- Quitman
- Rabun
- Randolph
- Richmond
- Rockdale
- Schley
- Screven
- Seminole
- Spalding
- Stephens
- Stewart
- Sumter
- Talbot
- Taliaferro
- Tattnall
- Taylor
- Telfair
- Terrell
- Thomas
- Tift
- Toombs
- Towns
- Treutlen
- Troup
- Turner
- Twiggs
- Union
- Upson
- Walker
- Walton
- Ware
- Warren
- Washington
- Wayne
- Webster
- Wheeler
- White
- Whitfield
- Wilcox
- Wilkes
- Wilkinson
- Worth
South Carolina Counties Served
- Abbeville
- Aiken
- Allendale
- Anderson
- Bamberg
- Barnwell
- Beaufort
- Berkeley
- Charleston
- Chester
- Chesterfield
- Clarendon
- Colleton
- Darlington
- Dillon
- Dorchester
- Edgefield
- Fairfield
- Florence
- Georgetown
- Greenville
- Greenwood
- Hampton
- Horry
- Kershaw
- Lancaster
- Lexington
- Marlboro
- Mccormick
- Newberry
- Orangeburg
- Richland
- Saluda
- Spartanburg
- Williamsburg
- York
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO)
How much does plan R2604-005 cost per month?
The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $9850.00 for 2027. After this limit is reached, covered in-network services are fully paid.
What is the current enrollment for UHC Medicare Advantage Patriot No Rx GS-MA01?
The plan has 1,065 enrolled beneficiaries according to CMS.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $0.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| UnitedHealthcare (official source) | http://UHC.com/Medicare | October 4, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.