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UHC Nursing Home Plan EX-F005 (PPO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Nursing Home Plan EX-F005 (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 EX-F005 (PPO I-SNP) in 2025, please refer to our full plan details page.
UHC Nursing Home Plan EX-F005 (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 MD, DE, RI, GA and OH. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Nursing Home Plan EX-F005 (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 EX-F005 (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 EX-F005 (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 EX-F005 (PPO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $45.80. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.60. 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 $11300.00 (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 $11300.00 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 EX-F005 (PPO I-SNP) has a defined standard drug benefit. The plan has a deductible of $590. After meeting the deductible, you will pay the costs for your prescriptions until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly premium is $45.80. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Part D covered drugs.
Additional Benefits
The UHC Nursing Home Plan EX-F005 (PPO I-SNP) offers a wide range of benefits, including no copay for primary care visits, routine eye exams, and many dental services. The plan also covers inpatient hospital stays with a $2,000 copay, and offers coverage for hearing aids, vision, and home health services. This plan provides coverage for a variety of outpatient services, with coinsurance ranging from 0% to 20% depending on the service. Additionally, the plan includes coverage for ambulance services with a 20% coinsurance, and offers other services like OTC items with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage, including both acute and psychiatric care, is covered by the UHC Nursing Home Plan EX-F005 (PPO I-SNP). The copay for a Medicare-covered stay is $2,000, and additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered with a coinsurance ranging from 0% to 20% depending on the service. Ambulatory Surgical Center (ASC) Services are covered with a coinsurance between 0% and 20%, and Outpatient Substance Abuse Services are covered with a coinsurance between 0% and 20%. Outpatient Blood Services are covered with a coinsurance between 0% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Nursing Home Plan EX-F005 (PPO I-SNP) with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by UHC Nursing Home Plan EX-F005 (PPO I-SNP). Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, including urgently needed services, are covered under this plan. Emergency services have a $110 copay, while urgently needed services have a copay between $0 and $40, and there is no coinsurance for either service. Worldwide emergency services are not covered.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with a 0% to 20% coinsurance and require prior authorization, while routine chiropractic care is not covered. Occupational Therapy Services are covered with no coinsurance and no copay. Physician Specialist Services and Mental Health Specialty Services are covered with a 0% to 20% coinsurance and require prior authorization. Podiatry Services are covered with a 0% to 20% coinsurance and no copay, including routine foot care with 2 visits every year. Other Health Care Professional services are covered with no copay and require prior authorization. Psychiatric Services are covered with a 0% to 20% coinsurance and require prior authorization. Physical Therapy and Speech-Language Pathology Services are covered with no copay and require prior authorization. Additional Telehealth Benefits are covered with no copay. Opioid Treatment Program Services are covered with no copay and require prior authorization.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, Kidney Disease Education Services with no copay, and other preventive services. Other preventive services include coverage for glaucoma screenings with 0-20% coinsurance, diabetes self-management training with no copay, barium enemas with no copay, digital rectal exams with 0-20% coinsurance, and EKG following Welcome Visit with 0-20% coinsurance. 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.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay and a coinsurance of at most 20%, while fitting/evaluation for hearing aids is not covered. Prescription hearing aids have no copay and a maximum benefit of $1500 per year, and OTC hearing aids have no copay.
Vision Services See details
Vision Services include eye exams and eyewear benefits. Routine eye exams have no copay, and routine eye exams are covered once per year. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay. The plan does not cover eyeglasses (lenses and frames), and upgrades.
Dental Services See details
The UHC Nursing Home Plan EX-F005 (PPO I-SNP) plan covers dental services, with no copay for 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), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery. Medicare dental services have a coinsurance of 0-20%, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the UHC Nursing Home Plan EX-F005 (PPO I-SNP). For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Nursing Home Plan EX-F005 (PPO I-SNP), but require prior authorization. You may pay between 0% and 20% coinsurance.
Medical Equipment See details
The UHC Nursing Home Plan EX-F005 (PPO I-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment has a 20% coinsurance. Prosthetics have a 0-20% coinsurance. Medical Supplies have a 20% coinsurance. Diabetic supplies and 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 and Diagnostic Radiological Services, have a coinsurance of up to 20%, while Lab Services have no copay. Outpatient X-Ray Services have no copay, and Therapeutic Radiological Services have a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the UHC Nursing Home Plan EX-F005 (PPO I-SNP) with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Nursing Home Plan EX-F005 (PPO I-SNP) with prior authorization required. For days 1-100, there is no copay, and additional and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, but acupuncture, meal benefits, and other services are not covered. Nicotine Replacement Therapy (NRT) and Naloxone are covered as a Part C OTC benefit.
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