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UHC Care Advantage OR-E001 (PPO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Care Advantage OR-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 OR-E001 (PPO I-SNP) in 2025, please refer to our full plan details page.
UHC Care Advantage OR-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 Oregon. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that UHC Care Advantage OR-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 OR-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 OR-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 OR-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 OR-E001 (PPO I-SNP) plan has a $195 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For tier 1 (Preferred Generic) drugs, there is no copay at the preferred pharmacy, and a $12 copay at the standard pharmacy. For tier 2 (Standard Generic) drugs, the copay is $47 at the standard pharmacy. For tier 3 (Preferred Brand) drugs, the copay is $100, regardless of the pharmacy. For tier 4 (Non-Preferred Drug) drugs, you pay 30% coinsurance. Once your total yearly drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your covered drugs.
Additional Benefits
The UHC Care Advantage OR-E001 (PPO I-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. It also covers primary care, preventive, hearing, vision, and dental services, often with no copay. Additionally, the plan includes coverage for ambulance, emergency, and home health services, with some services requiring coinsurance or prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a $200 copay for days 1-7 and no copay for days 8-90. Additional days for Inpatient Hospital-Acute have 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 ranging from $0 to $25 for individual sessions and a $15 copay for group sessions, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $100 copay for both ground and air ambulance services, and no copay for transportation services to a plan-approved health-related location, which covers up to 36 one-way trips per year via taxi or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered by the UHC Care Advantage OR-E001 (PPO I-SNP) plan. Emergency services have a $110 copay and no coinsurance, while urgently needed services have a copay of $0-$40 and no coinsurance. Worldwide emergency services have a $0 copay for worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation; all other services have no coinsurance.
Primary Care See details
Under the UHC Care Advantage OR-E001 (PPO I-SNP) plan, primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Chiropractic and specialist services have a copay of $0, and occupational therapy, physical therapy and speech-language pathology services, and other health care professional services have a copay between $0 and $25.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay. Additional preventive services are covered. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
The UHC Care Advantage OR-E001 (PPO I-SNP) plan covers hearing exams with no copay and routine hearing exams with no copay for 1 visit every year. The plan also covers prescription hearing aids, with a maximum plan benefit of $2200 every year, and OTC hearing aids with no copay. 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
The UHC Care Advantage OR-E001 (PPO I-SNP) plan covers vision services including eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglass lenses and eyeglass frames, are covered with no copay, and have a combined maximum benefit of $300 every year; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Care Advantage OR-E001 (PPO I-SNP) plan covers Medicare Dental Services with a 20% coinsurance 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, 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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the UHC Care Advantage OR-E001 (PPO I-SNP) plan and require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Under the UHC Care Advantage OR-E001 (PPO I-SNP) plan, Durable Medical Equipment (DME) is covered with 20% coinsurance and requires authorization. Prosthetics/Medical Supplies are covered with a 20% coinsurance for Medicare-covered supplies, and Diabetic Equipment is covered with varying cost sharing depending on the specific service.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the UHC Care Advantage OR-E001 (PPO I-SNP) plan. Diagnostic Procedures/Tests and Diagnostic and Therapeutic 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 UHC Care Advantage OR-E001 (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 covered, but the plan does not specify the cost sharing details. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Care Advantage OR-E001 (PPO I-SNP) plan. For days 1-100, there is no copay.
Other Services See details
The UHC Care Advantage OR-E001 (PPO I-SNP) plan covers Over-the-Counter (OTC) 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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