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UHC Nursing Home Plan NC-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 NC-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 NC-F001 (PPO I-SNP) in 2025, please refer to our full plan details page.
UHC Nursing Home Plan NC-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 North Carolina. 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 NC-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 NC-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 NC-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 NC-F001 (PPO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.20. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.60. 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 $6100.00 (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 $6100.00 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 NC-F001 (PPO I-SNP) has a defined standard drug benefit. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, you will pay $51.20 per month. During the initial coverage phase, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00, at which point you will enter the next coverage phase.
Additional Benefits
The UHC Nursing Home Plan NC-F001 (PPO I-SNP) offers a range of benefits including inpatient hospital stays with a $2,000 copay, outpatient services with varying coinsurance, and no copay for partial hospitalization. The plan also covers ambulance services with a 20% coinsurance, and transportation to plan-approved health-related locations with no copay, up to 24 one-way trips per year. This plan provides primary care physician services, physical therapy, speech-language pathology services, and home health services with no copay. It also covers hearing exams, prescription hearing aids, and vision services including routine eye exams and eyewear with no copay. Dental services include many services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric care, each with a $2,000 copay for a Medicare-covered stay, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a coinsurance of 0% - 10%, observation services with a 10% coinsurance, ambulatory surgical center (ASC) services with a coinsurance between 0% and 10%, outpatient substance abuse services with a coinsurance between 0% and 20% for individual and group sessions, and outpatient blood services with a coinsurance between 0% and 20%. This plan offers an enhanced benefit of three (3) pint deductible waived for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the UHC Nursing Home Plan NC-F001 (PPO I-SNP) plan, with both ground and air ambulance services subject to a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year via taxi or medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered under the UHC Nursing Home Plan NC-F001 (PPO I-SNP) with a $110 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently Needed Services are covered with a copay between $0 and $40 and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The UHC Nursing Home Plan NC-F001 (PPO I-SNP) covers primary care physician services with no copay. Chiropractic services are covered, but routine care is not covered, and the coinsurance is between 0% and 20%. Occupational therapy services are covered with no coinsurance and no copay. Physician specialist services, mental health specialty services (with 0-20% coinsurance for individual and group sessions), podiatry services (with 0-20% coinsurance for routine foot care), other health care professional services, psychiatric services (with 0-20% coinsurance for individual and group sessions), physical therapy and speech-language pathology services (with no copay), additional telehealth benefits (with no copay), and opioid treatment program services are covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and other preventive services with varying costs. Glaucoma screenings, digital rectal exams, and EKGs following a welcome visit have a 0%-20% coinsurance, while Barium Enemas and Diabetes Self-Management Training have no copay.
Hearing Services See details
The UHC Nursing Home Plan NC-F001 (PPO I-SNP) plan covers hearing exams with at most 20% coinsurance, and prescription hearing aids with no copay and a maximum benefit of $3,200 every year, but 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. The plan also covers OTC hearing aids with no copay.
Vision Services See details
The UHC Nursing Home Plan NC-F001 (PPO I-SNP) plan covers vision services, including routine eye exams with no copay, and eyewear, including contact lenses, eyeglass lenses, and eyeglass frames with no copay, and a combined maximum benefit of $300 every year; however, eyeglasses (lenses and frames) and upgrades are not covered. Eye exams may have a coinsurance of 0-20%.
Dental Services See details
Dental services include coverage for Medicare dental services with coinsurance between 0% and 20%, and other dental services. 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. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. The plan covers Medicare Part B insulin drugs with a $35 copay and 0-20% coinsurance, and covers Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Nursing Home Plan NC-F001 (PPO I-SNP), but require prior authorization. The coinsurance ranges from 0% to 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 0-20% coinsurance, and Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of up to 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 NC-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 NC-F001 (PPO I-SNP). Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Nursing Home Plan NC-F001 (PPO I-SNP) with a prior authorization requirement. For days 1-100, there is no copay.
Other Services See details
Other Services in the UHC Nursing Home Plan NC-F001 (PPO I-SNP) covers over-the-counter items with no copay. 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, and Self-Directed Personal Assistance Services are not covered.
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