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UHC Nursing Home Plan TX-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 TX-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 TX-F001 (PPO I-SNP) in 2025, please refer to our full plan details page.
UHC Nursing Home Plan TX-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 Texas. 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 TX-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 TX-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 TX-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 TX-F001 (PPO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. 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 $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 $6200.00 (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 $6200.00 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 TX-F001 (PPO I-SNP) has a defined standard drug benefit. The plan includes a deductible of $590.00. If you qualify for the low-income subsidy, your monthly premium for Part D drugs will be $18.30. After you pay the deductible, you will pay the 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 TX-F001 (PPO I-SNP) offers a range of benefits with varying cost-sharing options. Inpatient hospital stays have a $2,000 copay, and emergency services have a $110 copay, while many outpatient services, including primary care, preventive services, hearing exams, and routine eye exams, have no copay. The plan also covers several services with coinsurance, such as outpatient services, ambulance services, and medical equipment. Dental services, hearing aids, and vision services are covered with no copay for some services, but have maximum annual benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, each with a copay of $2,000 for a Medicare-covered stay. Additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all 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 0% to 20% coinsurance, and outpatient blood services with a 0% to 20% coinsurance. The plan also waives the three-pint deductible for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Nursing Home Plan TX-F001 (PPO I-SNP) with no copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Nursing Home Plan TX-F001 (PPO I-SNP), including ground and air ambulance services with a 20% coinsurance, and transportation services to a plan-approved health-related location with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by UHC Nursing Home Plan TX-F001 (PPO I-SNP). Emergency Services have a $110 copay, and Urgently Needed Services have a copay between $0 and $40; both have no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
The UHC Nursing Home Plan TX-F001 (PPO I-SNP) covers primary care physician services with no copay. Chiropractic services are covered with a coinsurance between 0% and 20%, while routine chiropractic care is not covered.
Preventive Services See details
The UHC Nursing Home Plan TX-F001 (PPO I-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are partially covered, with no copay for home and bathroom safety devices and modifications, and kidney disease education services. Other preventive services are covered with varying coinsurance and copays: glaucoma screening, digital rectal exams, and EKG following a welcome visit have a 0-20% coinsurance, while barium enemas and diabetes self-management training have no copay.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams are covered with no copay and no coinsurance, while fitting/evaluation for hearing aids are not covered. Prescription hearing aids have a maximum benefit of $3200 per year for both in and out-of-network services, and are covered with no copay. OTC hearing aids are covered with no copay.
Vision Services See details
The UHC Nursing Home Plan TX-F001 (PPO I-SNP) plan covers eye exams with 0%-20% coinsurance and routine eye exams with no copay. Eyewear benefits are covered, with contact lenses, eyeglass lenses, and eyeglass frames with no copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Nursing Home Plan TX-F001 (PPO I-SNP) plan covers Medicare Dental Services with a 0-20% coinsurance, and other dental services with a maximum benefit of $4,500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, 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, while orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the UHC Nursing Home Plan TX-F001 (PPO I-SNP), including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Nursing Home Plan TX-F001 (PPO I-SNP) plan, but require prior authorization. The coinsurance for these services ranges from 0% to 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), is covered with a 20% coinsurance and requires authorization. Prosthetics, medical supplies, and diabetic equipment are also covered with a 20% coinsurance for some services, with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests and Diagnostic Radiological Services with a coinsurance of up to 20%, Lab Services with no copay, Therapeutic Radiological Services with a 20% coinsurance, and Outpatient X-Ray Services with no copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the UHC Nursing Home Plan TX-F001 (PPO I-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required and coinsurance may apply.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the UHC Nursing Home Plan TX-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 TX-F001 (PPO I-SNP) plan does not cover acupuncture, meal benefits, or Dual Eligible SNPs with Highly Integrated Services. Over-the-counter items are covered with no copay. Other services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more.
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