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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 2025, 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 2025.
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 $68.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $71.00. 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 $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 $4200.00 (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 $4200.00 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) has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on the tier and the pharmacy you use. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your drugs. If you qualify for the low-income subsidy, your monthly premium will be $68.60.
Additional Benefits
The UHC Nursing Home Plan NY-F001 (PPO I-SNP) offers a wide range of benefits, including coverage for inpatient hospital stays with a $1,500 copay, outpatient services with a coinsurance of 0-20%, and emergency services with a $50 copay. This plan also provides coverage for various services such as primary care, preventive services, hearing, vision, and dental, with varying cost-sharing amounts like no copays, coinsurance, and annual maximums. Additional benefits include coverage for ambulance services with a 20% coinsurance, home health services with no copay, and skilled nursing facility services with no copay for days 1-100. The plan also covers home infusion bundled services, dialysis services, and medical equipment, with varying coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $1,500 for a Medicare-covered stay. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a 0% - 20% coinsurance, observation services with a 20% coinsurance, and ambulatory surgical center (ASC) services with a 0% - 20% coinsurance. Outpatient substance abuse services, including individual and group sessions, are covered with a 0% - 20% coinsurance. Outpatient blood services are also covered with a 0% - 20% coinsurance, and the plan waives the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Nursing Home Plan NY-F001 (PPO I-SNP), with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Nursing Home Plan NY-F001 (PPO I-SNP), including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, for up to 18 one-way trips per year via taxi or medical transport, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered under the UHC Nursing Home Plan NY-F001 (PPO I-SNP) with a $50 copay and no coinsurance, while Urgently Needed Services have a copay between $0 and $30 and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The UHC Nursing Home Plan NY-F001 (PPO I-SNP) plan covers primary care physician services with no copay, and chiropractic services with 0% to 20% coinsurance. The plan also covers occupational therapy services, with no coinsurance and no copay. The plan also covers physician specialist services, with 0% to 20% coinsurance, and mental health specialty services with 0% to 20% coinsurance. Podiatry services are covered with 0% to 20% coinsurance and no copay. Other health care professional, psychiatric services, and physical therapy and speech-language pathology services are also covered with no copay. Additional telehealth benefits are covered with no copay, and Opioid Treatment Program Services are covered with no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as coverage for additional preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a welcome visit. Glaucoma screenings, digital rectal exams, and EKGs have a 0%-20% coinsurance, while barium enemas and diabetes self-management training have no copay.
Hearing Services See details
Hearing services include routine hearing exams with no copay and at most 20% coinsurance, and OTC hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay up to a $2,200 annual benefit, and fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services are covered, including routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames. Routine eye exams have no copay and a coinsurance of 0-20%, while contact lenses, eyeglass lenses, and eyeglass frames have no copay; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for various services, with a yearly maximum benefit of $3,250. Preventive services like oral exams, x-rays, cleanings, and fluoride treatments have no copay, while other services like restorative services, endodontics, and periodontics require prior authorization and have no copay.
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 other Medicare Part B drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Nursing Home Plan NY-F001 (PPO I-SNP) with prior authorization. You will pay between 0% and 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and a prior authorization is required. Medical Supplies have a 20% coinsurance, while Prosthetic Devices have a 0-20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Lab Services and Outpatient X-Ray Services have no copay, while Diagnostic Procedures/Tests, Diagnostic Radiological Services, and Therapeutic Radiological Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the UHC Nursing Home Plan NY-F001 (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 cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and coinsurance may apply.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Nursing Home Plan NY-F001 (PPO I-SNP) with no copay for days 1-100, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required for this benefit.
Other Services See details
The "Other Services" benefit for UHC Nursing Home Plan NY-F001 (PPO I-SNP) 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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