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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 2025, 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 and NH, Select Counties in ME and NJ. 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 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 $53.10. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.20. 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 $6700.00 (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 $6700.00 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) has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. This plan's premium may be reduced if you qualify for the low-income subsidy, with the Part D premium costing $53.10. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Nursing Home Plan EX-F003 (PPO I-SNP) offers a range of benefits, including coverage for inpatient hospital stays with a $2,000 copay, and outpatient services with varying coinsurance rates. The plan also covers a wide array of services with no copay, such as primary care, hearing exams, routine vision exams, and many dental services, with a maximum dental benefit of $3,250 per year. Additional benefits include ambulance and transportation services with a 20% coinsurance, and emergency services with a $110 copay. Home health services, skilled nursing facility services for days 1-100, and home infusion bundled services are covered. However, services such as Cardiac Rehabilitation, additional hours of care, and certain other services are not covered by the plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under this plan, but the plan does not cover additional days or non-Medicare-covered stays. For Medicare-covered stays, there is a copay of $2,000.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a coinsurance of 0% to 20%, observation services have a 20% coinsurance, outpatient substance abuse services have a coinsurance of 0% to 20%, and outpatient blood services have a coinsurance of 0% to 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Nursing Home Plan EX-F003 (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, including ground and air ambulance services with a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 36 one-way trips per year via taxi or medical transport. 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 the UHC Nursing Home Plan EX-F003 (PPO I-SNP). Emergency Services have a $110 copay and no coinsurance, and the copay is waived if admitted to the hospital within 24 hours; Urgently Needed Services have a copay between $0 and $40, and no coinsurance; and Worldwide Emergency Services are not covered.
Primary Care See details
The UHC Nursing Home Plan EX-F003 (PPO I-SNP) covers primary care physician services with no copay, chiropractic services with 0% to 20% coinsurance, occupational therapy services with no coinsurance and no copay, physician specialist services with 0% to 20% coinsurance, mental health specialty services with 0% to 20% coinsurance, podiatry services with 0% to 20% coinsurance and no copay, other health care professional services with no copay, psychiatric services with 0% to 20% coinsurance, physical therapy and speech-language pathology services with no copay and no coinsurance, additional telehealth benefits with no copay, and opioid treatment program services with no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services with a copay. Specifically, the plan covers Glaucoma Screenings, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visits. The plan does not cover Health Education, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, and Counseling Services.
Hearing Services See details
Hearing Services include coverage for hearing exams, routine hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay, and prescription hearing aids (all types) have no copay, while OTC hearing aids have no copay.
Vision Services See details
The UHC Nursing Home Plan EX-F003 (PPO I-SNP) covers vision services, including eye exams with 0% - 20% coinsurance, and eyewear. Routine eye exams have no copay, while contact lenses, eyeglass lenses, and eyeglass frames have no copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Nursing Home Plan EX-F003 (PPO I-SNP) plan covers dental services, with a maximum benefit of $3,250 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, 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, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay with 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the UHC Nursing Home Plan EX-F003 (PPO I-SNP). There is a minimum coinsurance of 0% and a maximum coinsurance of 20% for these services, and prior authorization is required.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), with a 20% coinsurance and no copay. Prosthetic devices have a 0-20% coinsurance, while medical supplies have a 20% coinsurance and no copay. Diabetic equipment is covered with a 20% coinsurance for diabetic supplies and therapeutic shoes/inserts, and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered by the UHC Nursing Home Plan EX-F003 (PPO I-SNP). Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services and Outpatient X-Ray Services have no copay. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the UHC Nursing Home Plan EX-F003 (PPO I-SNP) with no copay and no coinsurance. However, 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 EX-F003 (PPO I-SNP). This includes Cardiac Rehabilitation Services, 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 under the UHC Nursing Home Plan EX-F003 (PPO I-SNP), with no copay for days 1-100. However, additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with no copay. Acupuncture, Meal Benefit, 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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