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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 2026, 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 2026.
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 $10.50. 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 $270.00 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 $6300.00 (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 $6300.00 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) Medicare plan features an annual drug deductible of $270. Tier 1 preferred generic drugs offer excellent savings with no copay for 1-month and 3-month supplies at standard pharmacies or via mail order. Tier 2 generic medications carry a $12 copay for a 1-month supply at standard pharmacies, though you can save with no copay for a 3-month supply using preferred mail order. For brand-name and specialty medications, costs are based on coinsurance. Tier 3 preferred brand drugs require a 25% coinsurance for both standard pharmacies and mail order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 45% and 30% coinsurance respectively for a 1-month supply at standard pharmacies and through mail order.
Additional Benefits
The UHC Care Advantage WA-E001 (PPO I-SNP) plan offers comprehensive medical coverage with no copays for primary care visits, telehealth services, and skilled nursing facility stays up to 100 days. Inpatient hospital stays require a daily copay of $350 for the first seven days, after which there is no copay, while specialist visits feature low copayments ranging up to $35. Emergency room visits carry a $150 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also features strong supplemental coverage, offering routine hearing, vision, and dental services with no copays and generous annual limits. Preventive and comprehensive dental care is covered with no copay up to a $2,000 annual limit, though Medicare-covered dental services and durable medical equipment require a 20% coinsurance. Additionally, members benefit from no-copay routine transportation for up to 36 one-way trips per year to plan-approved locations.
Inpatient Hospital See details
UHC Care Advantage WA-E001 (PPO I-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $350 daily copay for days 1 through 7 and no copay for days 8 and beyond. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
UHC Care Advantage WA-E001 (PPO I-SNP) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services require no coinsurance and feature copays ranging from no copay up to $350, while outpatient substance abuse sessions have no coinsurance and copays ranging from no copay up to $25.
Partial Hospitalization See details
Partial hospitalization is covered by UHC Care Advantage WA-E001 (PPO I-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UHC Care Advantage WA-E001 (PPO I-SNP), with a $155 copay and no coinsurance for ground and air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by UHC Care Advantage WA-E001 (PPO I-SNP) with a $150 copay and no coinsurance, and this copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a copay ranging from no copay to $65 and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
UHC Care Advantage WA-E001 (PPO I-SNP) covers primary care physician visits, telehealth, podiatry, and opioid treatment services with no copay and no coinsurance. Specialist visits, mental health, psychiatric, and therapy services are covered with no coinsurance and copayments ranging from $0 to $35, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by UHC Care Advantage WA-E001 (PPO I-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, and home safety devices. However, several supplemental sub-services are not covered, including fitness benefits, health education, personal emergency response systems, in-home safety assessments, medical nutrition therapy, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by UHC Care Advantage WA-E001 (PPO I-SNP) with no copay and no coinsurance for covered services, including one routine hearing exam per year and up to two prescription or OTC hearing aids every two years with a $2,200 maximum benefit limit. However, hearing aid fitting and evaluation exams, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services are partially covered by UHC Care Advantage WA-E001 (PPO I-SNP) with no copay and no coinsurance for routine eye exams and select eyewear, including contact lenses, lenses, and frames up to a $300 annual limit. Other eye exams, upgrades, and bundled eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by UHC Care Advantage WA-E001 (PPO I-SNP), with orthodontics not covered under the plan. Medicare-covered dental services require no copay and 20% coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance up to a $2,000 annual maximum for both in-network and out-of-network benefits.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Care Advantage WA-E001 (PPO I-SNP) with no copay, although prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
UHC Care Advantage WA-E001 (PPO I-SNP) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
UHC Care Advantage WA-E001 (PPO I-SNP) covers durable medical equipment (DME) and medical supplies with no copay and 20% coinsurance, subject to prior authorization. Prosthetic devices feature no copay and range from no coinsurance to 20% coinsurance, while diabetic supplies have no copay and therapeutic shoes or inserts carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Care Advantage WA-E001 (PPO I-SNP) with prior authorization. Lab services and outpatient X-rays have no copay but require coinsurance, diagnostic radiological services require a copay and no coinsurance, and diagnostic procedures and therapeutic radiology require 20% coinsurance.
Home Health Services See details
Home Health Services are covered by UHC Care Advantage WA-E001 (PPO I-SNP) 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 Care Advantage WA-E001 (PPO I-SNP) plan, as there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
UHC Care Advantage WA-E001 (PPO I-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, though prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UHC Care Advantage WA-E001 (PPO I-SNP) provides partial coverage for other services, offering over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and dual-eligible highly integrated services are not covered under this benefit.
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