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UHC Medicare Advantage NH-001A (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Medicare Advantage NH-001A (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Medicare Advantage NH-001A (PPO) in 2025, please refer to our full plan details page.
UHC Medicare Advantage NH-001A (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of New Hampshire. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Medicare Advantage NH-001A (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about UHC Medicare Advantage NH-001A (PPO).
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 Medicare Advantage NH-001A (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $33.80. 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 $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 $14000.00 (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 $14000.00 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 Medicare Advantage NH-001A (PPO) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy, you will pay $33.80.
Additional Benefits
The UHC Medicare Advantage NH-001A (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance. Emergency, urgent, and primary care services have copays or coinsurance, while many services like vision, dental, and home health have no copay. The plan also covers hearing aids and offers some preventive services, as well as coverage for medical equipment and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. The plan has a copay of $1880 per admission or stay for Medicare-covered stays, and covers additional days for Inpatient Hospital-Acute with no copay for days 91-999. However, 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 are covered, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a coinsurance of 0% - 20%, Observation Services have a 20% coinsurance, ambulatory surgical center services have a coinsurance of 0% - 20%, individual sessions for outpatient substance abuse have a coinsurance of 0% - 20%, group sessions for outpatient substance abuse have a 20% coinsurance, and outpatient blood services have a 20% coinsurance with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Medicare Advantage NH-001A (PPO) plan, and requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, and transportation services to plan-approved health-related locations. Ground and air ambulance services have a 20% coinsurance, and transportation services have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the UHC Medicare Advantage NH-001A (PPO) plan. Emergency services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.
Primary Care See details
The UHC Medicare Advantage NH-001A (PPO) plan covers primary care services with a coinsurance of 0% to 20%, chiropractic services with a 20% coinsurance, and occupational therapy services with a coinsurance of 0% to 20%. The plan also covers physician specialist services, mental health specialty services, podiatry services with no copay, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, and additional telehealth benefits with no copay. Opioid treatment program services are covered with no copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services with copays for Fitness Benefits and Home and Bathroom Safety Devices and Modifications. Other services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids is not covered. Prescription hearing aids are covered with a maximum benefit of $1500 every year, and OTC hearing aids are covered with no copay for 2 hearing aids every year.
Vision Services See details
The UHC Medicare Advantage NH-001A (PPO) plan covers vision services, including routine eye exams and eyewear. Routine eye exams and eyewear have no copay, and contact lenses and eyeglass lenses are covered with no copay.
Dental Services See details
Dental Services, including 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, and oral and maxillofacial surgery, are covered with no copay. Medicare Dental Services are covered with 20% coinsurance, and orthodontics and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. 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 by the UHC Medicare Advantage NH-001A (PPO) plan, with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies - Non-Medicare benefit with 20% coinsurance. Diabetic Equipment is covered, with Diabetic Supplies having no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the UHC Medicare Advantage NH-001A (PPO) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the UHC Medicare Advantage NH-001A (PPO) plan 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 under the UHC Medicare Advantage NH-001A (PPO) plan. While some services like Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Additional Cardiac Rehabilitation Services, Medicare-covered Intensive Cardiac Rehabilitation Services, and Medicare-covered Pulmonary Rehabilitation Services are mentioned, none of these sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered days, or non-Medicare-covered stays. Prior authorization is required, and the cost sharing is the same as Original Medicare.
Other Services See details
The UHC Medicare Advantage NH-001A (PPO) plan covers Over-the-Counter (OTC) Items and Meal Benefits, with no copay for OTC items. Acupuncture, 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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