UHC Medicare Advantage Patriot No Rx GS-MA01 (PPO) Medicare Advantage Plan R2604-005 • 2026 • Dorchester County, SC

UHC Medicare Advantage Patriot No Rx GS-MA01 Overview

Plan Overview for UHC Medicare Advantage Patriot No Rx GS-MA01

This Medicare Advantage PPO plan covers Medicare Part A and Part B services and allows access to Medicare-approved providers. The monthly premium is $0.00, with lower costs when using in-network providers.

Primary care visits have a $0 copay | Out-of-network: $0 copay, specialist visits come with a $0-$55 copay | Out-of-network: $55 copay, urgent care services carry a $0-$40 copay, and ambulance transportation is $290 copay | Out-of-network: $290 copay. These costs apply toward the plan’s annual maximum out-of-pocket (MOOP) limit of $9250.00. After this limit is reached, in-network services are fully covered for the remainder of the year.

This plan is listed by CMS under Plan ID R2604-005. Cost-sharing details for key services are provided below.

Cost Sharing Expenses

UHC Medicare Advantage Patriot No Rx GS-MA01 has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan R2604-005.

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 Star Ratings

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.