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UHC Nursing Home Plan EX-F003 (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-F003 (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-F003 (PPO I-SNP) in 2026, please refer to our full plan details page.
UHC Nursing Home Plan EX-F003 (PPO I-SNP) is a PPO I-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in States of CT, Select Counties in ME, NJ, and NH. 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-F003 (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-F003 (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-F003 (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-F003 (PPO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $42.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.80. 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-F003 (PPO I-SNP) features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Specific drug coverage tier details, including individual copays and coinsurance rates for different medication levels, are currently not available for this plan. To fully understand your potential out-of-pocket medication costs, it is recommended to review the plan's specific formulary or contact the provider directly.
Additional Benefits
The UHC Nursing Home Plan EX-F003 (PPO I-SNP) offers comprehensive medical coverage with no copay for primary care, specialist visits, home health services, and skilled nursing facility stays up to 100 days. For inpatient hospital stays, members pay a copayment of $2,135 per acute stay and $2,080 per psychiatric stay, with no coinsurance required. Emergency room visits carry a $115 copay, which is waived if admitted, while outpatient services generally feature no copays but require coinsurance ranging from 0% to 20%. This plan also provides valuable routine care, including preventive dental, annual routine eye exams, and prescription hearing aids up to $2,200 every two years with no copay. Diagnostic lab tests, over-the-counter items, and up to 36 one-way transportation trips are fully covered with no copay or coinsurance. Most other specialized services, including dialysis, medical equipment, and routine hearing exams, require no copay and a standard 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by UHC Nursing Home Plan EX-F003 (PPO I-SNP) with no coinsurance, requiring a copayment of $2,135 per Medicare-covered acute stay and $2,080 per psychiatric stay. Additional days, upgrades, and non-Medicare-covered stays are not covered, and prior authorization is required for both acute and psychiatric services.
Outpatient Services See details
Outpatient services under the UHC Nursing Home Plan EX-F003 (PPO I-SNP) are covered with no copays, but coinsurance and prior authorization are required for most services. Covered benefits, including outpatient hospital, ambulatory surgical, substance abuse, and blood services, feature coinsurance ranging from 0% (no coinsurance) to 20%.
Partial Hospitalization See details
Partial hospitalization is covered under the UHC Nursing Home Plan EX-F003 (PPO I-SNP) with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
UHC Nursing Home Plan EX-F003 (PPO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, providing up to 36 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by the UHC Nursing Home Plan EX-F003 (PPO I-SNP) with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services are covered with no coinsurance and a copay ranging from no copay to $40, but worldwide emergency services are not covered.
Primary Care See details
Primary Care benefits are covered under the UHC Nursing Home Plan EX-F003 (PPO I-SNP) with no copay for primary care, specialist, and therapy services, with coinsurance ranging from 0% to 20% depending on the service. Telehealth and opioid treatment program services feature no copay and no coinsurance, while chiropractic services are not covered in practice.
Preventive Services See details
Preventive Services are partially covered by UHC Nursing Home Plan EX-F003 (PPO I-SNP), offering no copay and no coinsurance for annual physicals, kidney disease education, and home safety modifications, but excluding fitness benefits, health education, in-home support, and counseling. Glaucoma screenings, digital rectal exams, and post-welcome visit EKGs are covered with a 20% coinsurance and no copay.
Hearing Services See details
UHC Nursing Home Plan EX-F003 (PPO I-SNP) covers routine hearing exams once yearly with no deductible, no copay, and a 20% coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids—up to a $2,200 limit every two years—and over-the-counter hearing aids are covered with no copay and no coinsurance, although inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
UHC Nursing Home Plan EX-F003 (PPO I-SNP) partially covers vision services, featuring one annual routine eye exam 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 combined limit, but upgrades and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered under the UHC Nursing Home Plan EX-F003 (PPO I-SNP), which offers Medicare-covered dental services with no copay and 20% coinsurance, as well as preventive services like exams, cleanings, fluoride, and x-rays with no copay and no coinsurance. Services that are not covered under this plan include other diagnostic services, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by UHC Nursing Home Plan EX-F003 (PPO I-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Nursing Home Plan EX-F003 (PPO I-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
UHC Nursing Home Plan EX-F003 (PPO I-SNP) covers medical equipment, including durable medical equipment (DME), medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Covered prosthetic devices also require no copay, with coinsurance ranging from no coinsurance up to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the UHC Nursing Home Plan EX-F003 (PPO I-SNP), with prior authorization required. Outpatient diagnostic procedures and tests require a copay and 20% coinsurance, while lab services require no copay. Radiological services require no copay, featuring 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-F003 (PPO I-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by UHC Nursing Home Plan EX-F003 (PPO I-SNP) with no copay and require prior authorization, though only some services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
UHC Nursing Home Plan EX-F003 (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 3-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 by UHC Nursing Home Plan EX-F003 (PPO I-SNP), which offers over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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