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UHC Care Advantage OH-E001 (PPO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Care Advantage OH-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 OH-E001 (PPO I-SNP) in 2025, please refer to our full plan details page.
UHC Care Advantage OH-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 Ohio. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that UHC Care Advantage OH-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 OH-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 OH-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 OH-E001 (PPO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.30. 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 OH-E001 (PPO I-SNP) plan has an "Enhanced Alternative" drug benefit. The plan has a deductible of $195. After the deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. During the initial coverage phase, you will pay a $12 copay for preferred generic drugs at standard pharmacies, and a $47 copay for standard generic drugs at standard pharmacies. Preferred and standard brand drugs have a $100 copay, and non-preferred drugs have a 30% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The UHC Care Advantage OH-E001 (PPO I-SNP) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. It also provides coverage for ambulance and transportation services, emergency services, and a range of primary care and preventive services, often with no copay. The plan includes additional benefits like hearing and vision services, dental services, and home infusion, with specific cost-sharing arrangements like copays and coinsurance for different services. This plan also covers a variety of other services, such as medical equipment, diagnostic and radiological services, and home health services. Some services, like skilled nursing facility care and partial hospitalization, may require prior authorization. While the plan provides a wide array of benefits, certain services such as cardiac rehabilitation, private duty nursing, and specific home and community-based services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $200 copay for days 1-7 and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you also pay 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, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$175, Observation Services with a $175 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay of $0-$25 for individual sessions and a $15 copay for group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $100 copay. Transportation services to plan-approved health-related locations are covered with no copay, up to 36 one-way trips per year via taxi or medical transport.
Emergency Services See details
Emergency Services are covered under the UHC Care Advantage OH-E001 (PPO I-SNP) plan with a $110 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $40 with no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have no copay and no coinsurance.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services has a $20 copay, and Routine Chiropractic Care is not covered. Individual and Group Sessions for Mental Health and Psychiatric Services have varying copays.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services, including Home and Bathroom Safety Devices and Modifications, with no copay. Other preventive services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are covered once per year. Prescription hearing aids are covered, with a maximum benefit of $2200 per year. OTC hearing aids are covered with no copay, and a quantity of 2 hearing aids is allowed every year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear has no copay, and the plan covers contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum of $250 per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other services like oral exams, dental x-rays, and other diagnostic and preventive services have no copay, while orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 Care Advantage OH-E001 (PPO I-SNP) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered by UHC Care Advantage OH-E001 (PPO I-SNP), including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the UHC Care Advantage OH-E001 (PPO I-SNP) plan. 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 also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by UHC Care Advantage OH-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 not covered by the UHC Care Advantage OH-E001 (PPO I-SNP) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UHC Care Advantage OH-E001 (PPO I-SNP) with prior authorization required, and there is no copay for days 1-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The UHC Care Advantage OH-E001 (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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