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UHC Care Advantage WA-E001 (PPO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Care Advantage WA-E001 (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 Care Advantage WA-E001 (PPO I-SNP) in 2025, please refer to our full plan details page.
UHC Care Advantage WA-E001 (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 Washington. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that UHC Care Advantage WA-E001 (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 Care Advantage WA-E001 (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 Care Advantage WA-E001 (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 Care Advantage WA-E001 (PPO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.20. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $195.00 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 Care Advantage WA-E001 (PPO I-SNP) plan has a $195.00 deductible for prescription drugs. After meeting the deductible, you will pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, you will pay a $12 copay for a preferred generic drug at a standard pharmacy. For preferred brand drugs, you will pay a $100 copay. If your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The UHC Care Advantage WA-E001 (PPO I-SNP) plan offers a range of benefits, including coverage for inpatient hospital stays with a $200 copay for the first 5 days, and no copay thereafter, as well as outpatient services with varying copays depending on the service. This plan also includes no copay for primary care visits, preventive services, hearing exams, vision exams, and many dental services. Emergency, urgent, and worldwide emergency services have no copay, and transportation to plan-approved health-related locations is covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $200 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $175, observation services with a $175 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with copays between $0 and $25 for individual sessions and $15 for group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
The UHC Care Advantage WA-E001 (PPO I-SNP) plan covers ambulance services with a $100 copay for both ground and air ambulance services, with no coinsurance. Transportation services to plan-approved health-related locations are covered for up to 36 one-way trips per year with no copay and no coinsurance, while 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 Care Advantage WA-E001 (PPO I-SNP) plan. Emergency Services have a $110 copay, and no coinsurance, while Urgently Needed Services have a copay between $0 and $40, and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay, and no coinsurance.
Primary Care See details
Under the UHC Care Advantage WA-E001 (PPO I-SNP) plan, Primary Care Physician Services have no copay, Chiropractic Services have a $20 copay, and Occupational Therapy Services have a copay between $0 and $15. Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services have a copay between $0 and $15, while Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have varying copays. Additional Telehealth Benefits have no copay.
Preventive Services See details
The UHC Care Advantage WA-E001 (PPO I-SNP) plan covers preventive services, including an annual physical exam with no copay. This plan also covers other preventive services such as Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
The UHC Care Advantage WA-E001 (PPO I-SNP) plan covers hearing exams with no copay, and routine hearing exams with no copay for one visit per year. The plan also covers prescription hearing aids up to $2200 per year with no copay for two hearing aids per year, and OTC hearing aids with no copay for two hearing aids per year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams, including routine eye exams, have no copay. Eyewear is covered, with a combined maximum of $300 every year for both in-network and out-of-network services, and contact lenses, eyeglass lenses, and eyeglass frames have no copay; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Care Advantage WA-E001 (PPO I-SNP) plan covers Medicare Dental Services with 20% coinsurance and other dental services with a $3,500 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, and other preventive dental services have no copay. 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, but 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 0-20%, while other Medicare Part B drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the UHC Care Advantage WA-E001 (PPO I-SNP) plan. Durable Medical Equipment has a 20% coinsurance and requires authorization. Prosthetic Devices have a 0-20% coinsurance, while Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. 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.
Home Health Services See details
Home Health Services are covered by the UHC Care Advantage WA-E001 (PPO I-SNP) plan 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 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UHC Care Advantage WA-E001 (PPO I-SNP), with no copay for days 1-100 and prior authorization required. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The UHC Care Advantage WA-E001 (PPO I-SNP) plan does not cover 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, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items are covered with no copay.
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