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UHC Nursing Home Plan NY-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 NY-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 NY-F001 (PPO I-SNP) in 2026, please refer to our full plan details page.
UHC Nursing Home Plan NY-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 New York. 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 NY-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 NY-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 NY-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 NY-F001 (PPO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $72.00. 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 NY-F001 (PPO I-SNP) requires an annual prescription drug deductible of $615. This is the amount you must pay out of pocket for your medications before the plan's drug coverage begins. Specific drug tier details, including copayments and coinsurance, are currently unavailable for this plan. To fully understand your potential drug costs, you should review the plan's formulary to verify how your specific prescriptions are covered. Knowing this $615 deductible amount is a crucial first step in evaluating if this PPO I-SNP meets your budget and medication needs.
Additional Benefits
The UHC Nursing Home Plan NY-F001 (PPO I-SNP) provides robust coverage for core medical services, featuring a $1,900 copay per stay with no coinsurance for inpatient hospital care and no copays for outpatient hospital services. Doctors' visits, specialists, and telehealth services require no copays, with coinsurance ranging from 0% to 20% depending on the provider. Additionally, diagnostic labs, outpatient X-rays, home health services, and the first 100 days of skilled nursing facility care are covered with no copays and no coinsurance. For supplemental care, the plan covers routine dental cleanings, annual physical exams, and up to 18 one-way transportation trips to approved medical locations with no copays or coinsurance. Routine vision and hearing exams are available with no copays and 20% coinsurance, alongside allowances for eyewear and hearing aids that feature no copays or coinsurance up to specified plan limits. Members also benefit from covered over-the-counter items, including nicotine replacement therapy, with no copays and no coinsurance.
Inpatient Hospital See details
UHC Nursing Home Plan NY-F001 (PPO I-SNP) covers inpatient acute and psychiatric hospital stays with a $1,900 copayment per stay and no coinsurance, requiring prior authorization. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the UHC Nursing Home Plan NY-F001 (PPO I-SNP) are covered with no copays, although prior authorization is required for most care. Covered outpatient hospital, ambulatory surgical center, and substance abuse services feature coinsurance ranging from no coinsurance to 20%, while outpatient blood services have no copay and 20% coinsurance with the deductible waived for the first three pints.
Partial Hospitalization See details
UHC Nursing Home Plan NY-F001 (PPO I-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
UHC Nursing Home Plan NY-F001 (PPO I-SNP) covers ambulance and transportation services with no copay and no coinsurance, though prior authorization is required for ambulance services. Transportation services are partially covered, offering up to 18 one-way trips per year to plan-approved health-related locations via taxi or medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
UHC Nursing Home Plan NY-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 a $0 to $40 copay and no coinsurance. 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 NY-F001 (PPO I-SNP) covers primary care, specialist, and mental health services with no copay and 0% to 20% coinsurance, and therapy services with no copay and 20% coinsurance. Telehealth and opioid treatment are available with no copay and no coinsurance, though some chiropractic services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
UHC Nursing Home Plan NY-F001 (PPO I-SNP) covers preventive services, including annual physical exams, kidney disease education, and diabetes training with no copay, while glaucoma screenings, digital rectal exams, and EKGs require a 20% coinsurance. Additional preventive benefits are only partially covered; home safety modifications have no copay and no coinsurance, but health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, fitness, disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
UHC Nursing Home Plan NY-F001 (PPO I-SNP) covers routine hearing exams once a year with a 20% coinsurance and no copay, while fitting and evaluation services are not covered. Prescription and OTC hearing aids are covered with no copay and no coinsurance for up to two devices every two years, with a $2,200 maximum benefit for prescription aids, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
UHC Nursing Home Plan NY-F001 (PPO I-SNP) partially covers vision services, including one routine eye exam annually with no copay and 20% coinsurance. Covered eyewear, such as contact lenses, eyeglass lenses, and frames, features no copay and no coinsurance up to a $300 yearly limit, though upgrades and other eye exam services are not covered.
Dental Services See details
UHC Nursing Home Plan NY-F001 (PPO I-SNP) offers partially covered dental services, featuring Medicare-covered dental care with no copay and 20% coinsurance, alongside preventive services like exams and cleanings with no copay and no coinsurance. Comprehensive services such as restorative treatments, endodontics, periodontics, prosthodontics, implants, oral surgery, orthodontics, and other diagnostic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Nursing Home Plan NY-F001 (PPO I-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the UHC Nursing Home Plan NY-F001 (PPO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
UHC Nursing Home Plan NY-F001 (PPO I-SNP) covers durable medical equipment, medical supplies, and diabetic equipment with no copay and 20% coinsurance. Prosthetic devices are also covered with no copay and range from no coinsurance to 20% coinsurance, with prior authorization required for all medical equipment.
Diagnostic and Radiological Services See details
UHC Nursing Home Plan NY-F001 (PPO I-SNP) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and outpatient X-rays, with no copayments and no coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Home Health Services are covered by UHC Nursing Home Plan NY-F001 (PPO I-SNP) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the UHC Nursing Home Plan NY-F001 (PPO I-SNP) are covered with no copay and require prior authorization, though some services are not covered in practice. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
The UHC Nursing Home Plan NY-F001 (PPO I-SNP) partially covers Skilled Nursing Facility (SNF) services, offering days 1 through 100 with no copayment and no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
UHC Nursing Home Plan NY-F001 (PPO I-SNP) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture and meal benefits are not covered. Covered OTC items include nicotine replacement therapy and naloxone with no maximum limit on plan coverage.
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