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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 2026, 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 2026.
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 $31.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.80. 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 $270.00 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 $6300.00 (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 $6300.00 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) prescription drug plan has an annual drug deductible of $270. For Tier 1 preferred generic drugs, you will pay no copay for standard pharmacy and mail order options. Tier 2 generic drugs cost a $12 copay for a one-month standard pharmacy supply, but you can pay no copay by choosing a three-month preferred mail order. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. You will pay a 25% coinsurance for Tier 3 preferred brand drugs and a 46% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply.
Additional Benefits
The UHC Care Advantage OH-E001 (PPO I-SNP) offers comprehensive medical coverage designed to minimize out-of-pocket expenses, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $350 copay for days one through seven and no copay for days eight through 90. Specialist visits range from no copay to a $35 copay, while services like dialysis and durable medical equipment require no copay and a 20% coinsurance. In addition to core medical services, this plan provides valuable routine benefits including dental, vision, and hearing care with no deductibles. Members receive routine dental care up to a $2,000 annual maximum and routine eye exams with a $250 annual allowance for eyewear, all with no copay and no coinsurance. Furthermore, the plan covers up to 36 one-way transportation trips and over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by UHC Care Advantage OH-E001 (PPO I-SNP) with no coinsurance, requiring a $350 copay for days 1 to 7 and no copay for days 8 to 90 for acute and psychiatric stays. While unlimited additional acute days are covered with no copay, additional psychiatric days, hospital upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by UHC Care Advantage OH-E001 (PPO I-SNP) with no coinsurance, featuring a copay of $0 to $350 for outpatient hospital and observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a copay of $0 to $25 and no coinsurance.
Partial Hospitalization See details
UHC Care Advantage OH-E001 (PPO I-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
UHC Care Advantage OH-E001 (PPO I-SNP) covers ground and air ambulance services with a $275 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance, providing up to 36 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
UHC Care Advantage OH-E001 (PPO I-SNP) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require no coinsurance and a copay ranging from $0 to $65, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Primary care services are covered by UHC Care Advantage OH-E001 (PPO I-SNP) with no copay and no coinsurance for primary care visits and telehealth, while specialist visits require a $0 to $35 copay and no coinsurance. Physical, occupational, and speech therapies have a $35 copay and no coinsurance, though chiropractic services are only partially covered as routine and other chiropractic services are not covered.
Preventive Services See details
UHC Care Advantage OH-E001 (PPO I-SNP) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. While home and bathroom safety devices are covered at no cost, other additional services such as fitness benefits, health education, and personal emergency response systems are not covered.
Hearing Services See details
UHC Care Advantage OH-E001 (PPO I-SNP) hearing services are partially covered with no copay, no coinsurance, and no deductible for covered care. The plan covers one routine hearing exam annually, up to two OTC hearing aids every two years, and up to $2,200 every two years for prescription hearing aids, but fitting and evaluation services, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by UHC Care Advantage OH-E001 (PPO I-SNP) with no deductible, no copay, and no coinsurance for covered services, which include one routine eye exam and eyewear up to a $250 annual limit. Other eye exams, eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Dental services are partially covered by UHC Care Advantage OH-E001 (PPO I-SNP), with orthodontics being the only service not covered. Medicare-covered dental services require no copay and a 20% coinsurance, while all other preventive and comprehensive dental services have no copay and no coinsurance up to a $2,000 annual maximum.
Home Infusion bundled Services See details
UHC Care Advantage OH-E001 (PPO I-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
UHC Care Advantage OH-E001 (PPO I-SNP) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
UHC Care Advantage OH-E001 (PPO I-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, though prosthetic devices range from no coinsurance to 20%. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under UHC Care Advantage OH-E001 (PPO I-SNP) with prior authorization, featuring no copay but requiring coinsurance for lab and outpatient X-ray services. Diagnostic procedures and tests require both a copay and 20% coinsurance, therapeutic radiology incurs a 20% coinsurance, and diagnostic radiology requires a copay with no coinsurance.
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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under UHC Care Advantage OH-E001 (PPO I-SNP), as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage. While the category technically features no coinsurance and no copay, none of the specific rehabilitation services are actually covered by the plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by UHC Care Advantage OH-E001 (PPO I-SNP) for days 1 through 100 with no copay and no coinsurance, and a prior three-day inpatient hospital stay is not required. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Other services are partially covered by UHC Care Advantage OH-E001 (PPO I-SNP), which offers over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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