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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 2026, 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 2026.
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 $36.20. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.40. 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 $615.00 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 $13900.00 (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 $13900.00 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) features an annual prescription drug deductible of $615. This means you must pay this deductible amount out of pocket for your covered medications before the plan starts helping with the costs. Detailed information regarding specific drug tiers, copayments, and coinsurance is currently unavailable for this plan. To understand how this plan will cover your specific prescriptions, it is best to consult the plan's formulary directly. Knowing your medication costs beforehand is a crucial step when deciding if this Medicare drug coverage fits your healthcare budget.
Additional Benefits
The UHC Nursing Home Plan NC-F001 (PPO I-SNP) offers comprehensive medical coverage, featuring inpatient hospital stays with copays starting at $2,080 and no coinsurance, alongside skilled nursing facility stays for up to 100 days with no copay or coinsurance. Outpatient services, primary care, and specialist visits generally require no copay, though coinsurance ranges from 0% to 20% depending on the service. Emergency care is covered with a $115 copay, which is waived if admitted, while urgent care visits carry a copay of up to $40. Members also benefit from routine care, including preventive and comprehensive dental services with no copay or coinsurance up to a $2,000 annual limit. Routine vision and hearing exams feature no copay with 20% coinsurance, alongside allowances of up to $300 annually for eyewear and $2,200 every two years for hearing aids. Additionally, the plan covers over-the-counter items, home health services, and medical equipment with no copays, though durable medical equipment requires a 20% coinsurance.
Inpatient Hospital See details
UHC Nursing Home Plan NC-F001 (PPO I-SNP) covers acute inpatient hospital stays with a $2,230 copay per stay and psychiatric inpatient hospital stays with a $2,080 copay per stay, both with no coinsurance and requiring prior authorization. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by UHC Nursing Home Plan NC-F001 (PPO I-SNP) with no copay, though prior authorization is required for most care. Covered outpatient hospital, ambulatory surgical, substance abuse, and blood services carry coinsurance ranging from no coinsurance up to 20%.
Partial Hospitalization See details
UHC Nursing Home Plan NC-F001 (PPO I-SNP) covers partial hospitalization with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
UHC Nursing Home Plan NC-F001 (PPO I-SNP) covers ambulance services with a 20% coinsurance and no copay, while transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations. Transportation to any health-related location is not covered.
Emergency Services See details
UHC Nursing Home Plan NC-F001 (PPO I-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted within 24 hours, and urgently needed services with no coinsurance and a copay of up to $40. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
UHC Nursing Home Plan NC-F001 (PPO I-SNP) covers primary care, specialist visits, and mental health services with no copay and 0% to 20% coinsurance, while telehealth and opioid treatment programs feature no copay and no coinsurance. Physical, occupational, and speech therapies require no copay and 20% coinsurance, but chiropractic services are not covered in practice.
Preventive Services See details
UHC Nursing Home Plan NC-F001 (PPO I-SNP) covers annual physical exams, kidney disease education, and home safety devices with no copay and no coinsurance, while screenings like glaucoma exams and EKGs require a 20% coinsurance and no copay. Additional preventive services are only partially covered, as the plan excludes benefits such as fitness programs, health education, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by UHC Nursing Home Plan NC-F001 (PPO I-SNP), which offers annual routine hearing exams with a 20% coinsurance and no copay, but does not cover hearing aid fittings or evaluations. Prescription and OTC hearing aids are covered with no copay and no coinsurance up to a $2,200 limit every two years, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by the UHC Nursing Home Plan NC-F001 (PPO I-SNP), which offers one routine eye exam per year with no copay and 20% coinsurance. Covered eyewear includes contact lenses, eyeglass lenses, and frames with no copay and no coinsurance up to a $300 annual maximum, while other eye exams, upgrades, and combined eyeglasses are not covered.
Dental Services See details
Dental services are partially covered by the UHC Nursing Home Plan NC-F001 (PPO I-SNP), which offers preventive and comprehensive care with no copay and no coinsurance up to a $2,000 annual maximum, excluding orthodontics. Medicare-covered dental services are also available with no copay and a 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by UHC Nursing Home Plan NC-F001 (PPO I-SNP) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other Part B drugs carry a coinsurance ranging from 0% to 20%, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Nursing Home Plan NC-F001 (PPO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical Equipment benefits under the UHC Nursing Home Plan NC-F001 (PPO I-SNP) are covered with no copay, though prior authorization is required. Members are responsible for a 20% coinsurance for durable medical equipment, medical supplies, and diabetic equipment, while prosthetic devices carry a coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the UHC Nursing Home Plan NC-F001 (PPO I-SNP) with prior authorization, featuring no copays for lab services or radiological services. Diagnostic procedures and tests require a copay and a minimum 20% coinsurance, while therapeutic radiology and outpatient X-rays require a minimum 20% coinsurance, and diagnostic radiology has no coinsurance.
Home Health Services See details
Home Health Services are covered by UHC Nursing Home Plan NC-F001 (PPO I-SNP) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
UHC Nursing Home Plan NC-F001 (PPO I-SNP) offers some covered Cardiac Rehabilitation Services with no copay and a 20% coinsurance, subject to prior authorization. However, several sub-services are not covered, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
UHC Nursing Home Plan NC-F001 (PPO I-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the UHC Nursing Home Plan NC-F001 (PPO I-SNP), which offers over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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