UHC Nursing Home Plan NY-F002 (PPO I-SNP)

Inpatient Hospital See details

Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and have a copay of $1,500 for a Medicare-covered stay. Additional days and non-Medicare-covered stays 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 coinsurance of 0% - 20%, Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a coinsurance between 0% and 20%, Outpatient Substance Abuse Services with a coinsurance between 0% and 20% for both individual and group sessions, and Outpatient Blood Services with a coinsurance of 0% - 20%. Additionally, three pints of blood are covered under this plan.

Partial Hospitalization See details

Partial Hospitalization is covered by the UHC Nursing Home Plan NY-F002 (PPO I-SNP) with no copay. Prior authorization is required for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered under the UHC Nursing Home Plan NY-F002 (PPO I-SNP). Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered with no copay for up to 18 one-way trips per year, while transportation services to any health-related location are not covered.

Emergency Services See details

Emergency Services are covered under the UHC Nursing Home Plan NY-F002 (PPO I-SNP) with a $50 copay, but no coinsurance. Urgently Needed Services are covered with a copay between $0 and $40, and no coinsurance, while Worldwide Emergency Services are not covered.

Primary Care See details

The UHC Nursing Home Plan NY-F002 (PPO I-SNP) plan covers primary care physician services with no copay. Chiropractic services are covered with a coinsurance of 0% to 20%, but routine care is not covered.

Occupational therapy services are covered with no coinsurance but may have a copay. Physician specialist services, mental health specialty services (individual and group sessions), and psychiatric services (individual and group sessions) are covered with a coinsurance of 0% to 20%.

Podiatry services are covered with a coinsurance of 0% to 20% and may have a copay, with routine foot care covered. Other health care professional services and opioid treatment program services are covered and may have a copay.

Physical therapy and speech-language pathology services are covered with no copay and no coinsurance. Additional telehealth benefits and are available with no copay.

Preventive Services See details

Preventive Services are covered, including an annual physical exam with no copay. Other preventive services are covered, but Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered. Glaucoma Screening and EKG following Welcome Visit have a 0-20% coinsurance, and Diabetes Self-Management Training, and Barium Enemas have no copay. Barium Enemas and Digital Rectal Exams have no copay, and Glaucoma Screening, and Digital Rectal Exams have a 0-20% coinsurance.

Hearing Services See details

Hearing Services include hearing exams and prescription hearing aids, with routine hearing exams covered with no copay and up to 20% coinsurance, and OTC hearing aids covered with no copay. Fitting/Evaluation for Hearing Aid, 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 include coverage for eye exams, with a coinsurance of 0% to 20%, and eyewear. Eyewear includes coverage for contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $200 per year.

Dental Services See details

The UHC Nursing Home Plan NY-F002 (PPO I-SNP) plan covers various dental services, including oral exams, x-rays, and cleanings, with no copay. Other services like fillings, root canals, and oral surgery also have no copay, but require prior authorization. This plan has a maximum annual benefit of $1750 for in and out-of-network services.

Home Infusion bundled Services See details

Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered by the UHC Nursing Home Plan NY-F002 (PPO I-SNP) and require prior authorization. You may have to pay a coinsurance between 0% and 20%.

Medical Equipment See details

The UHC Nursing Home Plan NY-F002 (PPO I-SNP) plan covers Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetic Devices with a 0-20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered with a 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts; 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, Diagnostic Radiological Services, and Therapeutic Radiological Services, are covered by the UHC Nursing Home Plan NY-F002 (PPO I-SNP) with a coinsurance of at most 20%. Lab Services and Outpatient X-Ray Services are covered with no copay.

Home Health Services See details

Home Health Services are covered 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 Nursing Home Plan NY-F002 (PPO I-SNP). This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the UHC Nursing Home Plan NY-F002 (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

Other Services includes coverage for over-the-counter items with no copay, but acupuncture, meal benefits, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, case management, institution for mental disease services for individuals 65 or older, services in an intermediate care facility for individuals with intellectual disabilities, 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.