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UHC Nursing Home Plan IN-F001 (PPO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Nursing Home Plan IN-F001 (PPO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Nursing Home Plan IN-F001 (PPO I-SNP) in 2025, please refer to our full plan details page.
UHC Nursing Home Plan IN-F001 (PPO I-SNP) is a PPO I-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Indiana. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that UHC Nursing Home Plan IN-F001 (PPO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
UHC Nursing Home Plan IN-F001 (PPO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about UHC Nursing Home Plan IN-F001 (PPO I-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For UHC Nursing Home Plan IN-F001 (PPO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.10. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8300.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8300.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The UHC Nursing Home Plan IN-F001 (PPO I-SNP) has a defined standard drug benefit. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, you will pay a monthly premium of $49.60. After you pay the deductible, you will pay costs for drugs in each tier until your total drug costs reach $2000.00, at which point you enter the next coverage phase.
Additional Benefits
The UHC Nursing Home Plan IN-F001 (PPO I-SNP) offers a range of benefits with varying cost-sharing. Many services have no copay, including primary care, preventive services like annual physical exams, home health, and skilled nursing facility stays for the first 100 days. Other services involve copays or coinsurance, such as inpatient hospital stays with a $1,870 copay, emergency services with a $110 copay, and outpatient services and hearing aids with coinsurance. The plan also covers dental services with a maximum benefit of $1750 per year, and provides transportation services up to 48 one-way trips per year.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $1,870 for a Medicare-covered stay. Additional days for Inpatient Hospital-Acute and Psychiatric, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a coinsurance between 0% and 20%, observation services with 20% coinsurance, ambulatory surgical center (ASC) services with a coinsurance between 0% and 20%, outpatient substance abuse services with a coinsurance between 0% and 20%, and outpatient blood services with a coinsurance between 0% and 20%. Prior authorization is required for these services.
Partial Hospitalization See details
Partial Hospitalization is covered with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
The UHC Nursing Home Plan IN-F001 (PPO I-SNP) covers ambulance services with a 20% coinsurance for both ground and air ambulance services, and transportation services with no copay. Transportation services to any health-related location are not covered, but transportation to plan-approved health-related locations are covered for up to 48 one-way trips per year.
Emergency Services See details
Emergency Services are covered under the UHC Nursing Home Plan IN-F001 (PPO I-SNP), with a copay of $110, and no coinsurance. Urgently Needed Services are also covered, with a copay between $0 and $40, and no coinsurance. Worldwide Emergency Services are not covered.
Primary Care See details
Under the UHC Nursing Home Plan IN-F001 (PPO I-SNP), primary care physician services, occupational therapy services, physical therapy, speech-language pathology services, and additional telehealth benefits are covered with no copay. Chiropractic services, physician specialist services, mental health specialty services, psychiatric services, and podiatry services are covered with 0-20% coinsurance. Other health care professional services and opioid treatment program services are covered with no copay.
Preventive Services See details
The UHC Nursing Home Plan IN-F001 (PPO I-SNP) plan covers preventive services, including an annual physical exam with no copay, as well as kidney disease education services with no copay. Other preventive services are covered, including glaucoma screenings with 0-20% coinsurance, diabetes self-management training and barium enemas with no copay, and digital rectal exams and EKG following a welcome visit with 0-20% coinsurance. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing services include coverage for hearing exams with a coinsurance of at most 20%, routine hearing exams with no copay, and prescription hearing aids with a maximum benefit of $2200 per year with no copay, while fitting/evaluation for hearing aids, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are covered with no copay.
Vision Services See details
Vision Services include eye exams, contact lenses, eyeglass lenses, and eyeglass frames. Routine eye exams have no copay and coinsurance, and you are allowed one exam per year. Contact lenses, eyeglass lenses, and eyeglass frames have no copay. Eyewear has a combined maximum benefit of $200 per year for both in-network and out-of-network services. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Nursing Home Plan IN-F001 (PPO I-SNP) plan covers Medicare Dental Services with a coinsurance of 0% - 20%, and covers other dental services with a maximum plan benefit of $1750 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis, fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery are covered with no copay; however, orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Insulin has a $35 copay, with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the UHC Nursing Home Plan IN-F001 (PPO I-SNP) plan. You may have to pay between 0% and 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices have a 0-20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with varying cost-sharing depending on the service. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of up to 20%, and Therapeutic Radiological Services have a 20% coinsurance. Lab Services and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the UHC Nursing Home Plan IN-F001 (PPO I-SNP) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the UHC Nursing Home Plan IN-F001 (PPO I-SNP). This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Nursing Home Plan IN-F001 (PPO I-SNP), with no copay for days 1-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The UHC Nursing Home Plan IN-F001 (PPO I-SNP) plan covers over-the-counter items with no copay, but acupuncture, meal benefits, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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