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UHC Nursing Home Plan EX-F002 (PPO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Nursing Home Plan EX-F002 (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 EX-F002 (PPO I-SNP) in 2026, please refer to our full plan details page.
UHC Nursing Home Plan EX-F002 (PPO I-SNP) is a PPO I-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of Delaware, Select Counties in Pennsylvania. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that UHC Nursing Home Plan EX-F002 (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 EX-F002 (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 EX-F002 (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 EX-F002 (PPO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.50. 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 $615.00 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 $13900.00 (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 $13900.00 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 EX-F002 (PPO I-SNP) features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your prescription medications before the plan begins to pay its share. Knowing this upfront cost is a key factor when deciding if this Medicare plan fits your budget and healthcare needs. Detailed information regarding specific drug tiers, copays, and coinsurance is not available for this plan. To determine your exact costs for specific medications, you will need to review the plan's formulary directly. Evaluating these drug coverage details ensures you choose the most cost-effective Medicare plan for your personal health requirements.
Additional Benefits
The UHC Nursing Home Plan EX-F002 (PPO I-SNP) offers robust medical coverage where many core services feature no copays, though coinsurance and prior authorizations frequently apply. Inpatient hospital stays require a copay of $2,230 per acute stay and $2,080 per psychiatric stay, with no coinsurance. Emergency care has a $115 copay, while primary care visits, home health services, and skilled nursing facility stays up to 100 days are covered with no copay and no coinsurance. Outpatient care, diagnostic tests, and dialysis generally require no copays but are subject to a standard 20% coinsurance. Supplemental benefits like dental care up to $2,000 annually and eyewear up to a $300 yearly limit are covered with no copay and no coinsurance. Members also receive over-the-counter items and up to 24 one-way transportation trips per year to plan-approved locations with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by the UHC Nursing Home Plan EX-F002 (PPO I-SNP) with no coinsurance, requiring prior authorization and a copay of $2,230 per acute stay and $2,080 per psychiatric stay. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
UHC Nursing Home Plan EX-F002 (PPO I-SNP) covers outpatient services with no copays, though prior authorization is required for most benefits. Patients will pay no copay and coinsurance ranging from no coinsurance up to 20% for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services, while outpatient blood services require a 20% coinsurance with no deductible for the first three pints.
Partial Hospitalization See details
UHC Nursing Home Plan EX-F002 (PPO I-SNP) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
UHC Nursing Home Plan EX-F002 (PPO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
UHC Nursing Home Plan EX-F002 (PPO I-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted within 24 hours, and urgently needed services with a copay of no copay to $40 and no coinsurance. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits under the UHC Nursing Home Plan EX-F002 (PPO I-SNP) are covered with no copays, though coinsurance ranges from 0% to 20% for primary care, specialist, and therapy services. While telehealth and opioid treatments have no coinsurance, chiropractic services are not covered in practice, and routine podiatry is limited to six visits per year with a 20% coinsurance.
Preventive Services See details
Preventive services are partially covered under the UHC Nursing Home Plan EX-F002 (PPO I-SNP), offering annual physical exams, kidney disease education, and home safety modifications with no copay and no coinsurance. Glaucoma screenings, digital rectal exams, and post-welcome visit EKGs require a 20% coinsurance and no copay, while other supplemental benefits like fitness, health education, and in-home support are not covered.
Hearing Services See details
Hearing services are partially covered by the UHC Nursing Home Plan EX-F002 (PPO I-SNP), offering routine hearing exams with no copay and a 20% coinsurance, while fitting and evaluation services are not covered. Prescription and OTC hearing aids are covered with no copay and no coinsurance up to plan limits, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by the UHC Nursing Home Plan EX-F002 (PPO I-SNP), which offers one routine eye exam per year with no copay and a 20% coinsurance, while other eye exams are not covered. Covered eyewear options like contact lenses, eyeglass lenses, and frames have no copay and no coinsurance up to a $300 annual limit, but upgrades and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by the UHC Nursing Home Plan EX-F002 (PPO I-SNP), providing preventive and comprehensive care with no copay and no coinsurance up to a $2,000 annual limit, though orthodontics are not covered. Medicare-covered dental services are also available with no copay and a 20% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Nursing Home Plan EX-F002 (PPO I-SNP) with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
UHC Nursing Home Plan EX-F002 (PPO I-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
UHC Nursing Home Plan EX-F002 (PPO I-SNP) covers medical equipment, including durable medical equipment, diabetic supplies, and medical supplies, with no copay and a 20% coinsurance. Prosthetic devices are also covered with no copay and a coinsurance ranging from no coinsurance to 20%, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
UHC Nursing Home Plan EX-F002 (PPO I-SNP) covers diagnostic and radiological services with prior authorization, featuring a copay and 20% coinsurance for diagnostic tests, and no copay for lab services. Radiological services have no copay, with no coinsurance for diagnostic radiology and a 20% coinsurance for therapeutic radiology and outpatient X-rays.
Home Health Services See details
UHC Nursing Home Plan EX-F002 (PPO I-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the UHC Nursing Home Plan EX-F002 (PPO I-SNP). This includes intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services, which are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
UHC Nursing Home Plan EX-F002 (PPO I-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the UHC Nursing Home Plan EX-F002 (PPO I-SNP), which provides over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this benefit.
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