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UHC Nursing Home Plan WA-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 WA-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 WA-F001 (PPO I-SNP) in 2025, please refer to our full plan details page.
UHC Nursing Home Plan WA-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 Washington. 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 WA-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 WA-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 WA-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 WA-F001 (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 $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 $8600.00 (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 $8600.00 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 WA-F001 (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 will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you'll pay $26.20. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The UHC Nursing Home Plan WA-F001 (PPO I-SNP) offers a range of benefits with varying cost-sharing structures. Inpatient hospital stays have a $2,000 copay, while outpatient services and other specialist services have coinsurance between 0% and 20%. Many services have no copay, including primary care visits, preventive services like annual physical exams, routine hearing exams, vision exams, and dental services. Additional benefits include coverage for ambulance services, and transportation to plan-approved health-related locations. The plan also covers home health services, skilled nursing facility services (days 1-100), and over-the-counter items, all with no copay. However, certain services like cardiac rehabilitation and private duty nursing are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $2,000 copay for a Medicare-covered stay. Additional days and non-Medicare-covered stays for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, as well as upgrades, are not covered.
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 between 0% and 10%, observation services have a 10% coinsurance, outpatient substance abuse services have a coinsurance between 0% and 20%, and outpatient blood services have a coinsurance between 0% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Nursing Home Plan WA-F001 (PPO I-SNP) with no copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services with a 20% coinsurance, and transportation services to a plan-approved health-related location with no copay; however, transportation services to any health-related location are not covered. Transportation services to a plan-approved health-related location are limited to 60 one-way trips per year via taxi or medical transport.
Emergency Services See details
Emergency Services are covered with a $110 copay and no coinsurance, while Urgently Needed Services have a copay between $0 and $40 and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with 0-20% coinsurance, Occupational Therapy Services with no coinsurance, and Physician Specialist Services with 0-20% coinsurance. Mental Health Specialty Services, including Individual and Group Sessions, are covered with 0-20% coinsurance. Podiatry Services, including Routine Foot Care, are covered with 0-20% coinsurance, and Other Health Care Professional services have no copay. Psychiatric Services, including Individual and Group Sessions, are covered with 0-20% coinsurance. Physical Therapy and Speech-Language Pathology Services are covered with no copay, Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have no copay.
Preventive Services See details
The UHC Nursing Home Plan WA-F001 (PPO I-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, such as glaucoma screenings, have a coinsurance of up to 20%, while services like diabetes self-management training, and barium enemas have no copay.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay and at most 20% coinsurance, with a limit of 1 exam per year. Prescription Hearing Aids (all types) have no copay, and a maximum benefit of $3200 every year, but the fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered. OTC hearing aids have no copay, and allow for 2 hearing aids every year.
Vision Services See details
The UHC Nursing Home Plan WA-F001 (PPO I-SNP) plan covers vision services, including eye exams with 0-20% coinsurance and routine eye exams with no copay, and eyewear with no copay. Eyeglass lenses and frames are covered with no copay. Contact lenses are covered with no copay. Eyeglass frames and upgrades are not covered.
Dental Services See details
The UHC Nursing Home Plan WA-F001 (PPO I-SNP) covers dental services with a maximum benefit of $3,500 per year for both in-network and out-of-network services. Oral exams, dental x-rays, other diagnostic services, prophylaxis, fluoride treatments, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery have no copay, while coinsurance ranges from 0% to 20% for Medicare dental services. Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, 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%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Nursing Home Plan WA-F001 (PPO I-SNP). There is a coinsurance between 0% and 20% for these services, and prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance. Prosthetic Devices have a 0-20% coinsurance, while Medical Supplies have a 20% coinsurance. Diabetic Supplies and Therapeutic Shoes/Inserts each have a 20% coinsurance.
Diagnostic and Radiological Services See details
The UHC Nursing Home Plan WA-F001 (PPO I-SNP) covers diagnostic and radiological services with prior authorization. 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 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the UHC Nursing Home Plan WA-F001 (PPO I-SNP) 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 not covered by the UHC Nursing Home Plan WA-F001 (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 by the UHC Nursing Home Plan WA-F001 (PPO I-SNP) with prior authorization required. For days 1-100, there is no copay.
Other Services See details
The UHC Nursing Home Plan WA-F001 (PPO I-SNP) plan covers 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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