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UHC Nursing Home Plan NY-F003 (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Nursing Home Plan NY-F003 (HMO 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-F003 (HMO I-SNP) in 2025, please refer to our full plan details page.
UHC Nursing Home Plan NY-F003 (HMO I-SNP) is a HMO 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 3.5 out of 5 stars in 2025.
It's important to know that UHC Nursing Home Plan NY-F003 (HMO 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-F003 (HMO 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-F003 (HMO 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-F003 (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $7.10. 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 Maximum Out-Of-Pocket cost of $6000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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-F003 (HMO I-SNP) has a defined standard drug benefit. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, you will pay $7.10 for Part D drugs. After you pay your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Nursing Home Plan NY-F003 (HMO I-SNP) offers a variety of benefits. This plan covers inpatient hospital stays with a $1500 copay, and outpatient services with varying coinsurance. This plan also provides coverage for primary care visits, home health services, and some vision and dental services. However, it's important to note that some services like hearing aids, and cardiac rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For both, the copay for a Medicare-covered stay is $1500, and additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. For outpatient hospital services and outpatient blood services, your coinsurance will be between 0% and 20%, while for observation services, your coinsurance is 20%. For individual and group sessions for outpatient substance abuse, the coinsurance is between 0% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Nursing Home Plan NY-F003 (HMO I-SNP) with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, with a limit of 12 one-way trips per year via taxi or medical transport.
Emergency Services See details
Emergency Services are covered by the UHC Nursing Home Plan NY-F003 (HMO I-SNP) with a $50 copay, but no coinsurance. Urgently Needed Services are covered with a copay between $0 and $40, 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-F003 (HMO I-SNP) plan covers primary care physician services with no copay, chiropractic services with a 0-20% coinsurance, occupational therapy with no copay and no coinsurance, physician specialist services with a 0-20% coinsurance, and mental health specialty services with a 0-20% coinsurance. The plan also covers physical therapy and speech-language pathology services with no copay and no coinsurance, additional telehealth benefits with no copay, and opioid treatment program services with no copay. Podiatry services are not covered.
Preventive Services See details
The UHC Nursing Home Plan NY-F003 (HMO I-SNP) covers preventive services, including an annual physical exam with no copay. Other preventive services are partially covered, with some services having a 0-20% coinsurance or no copay, and the following services not covered: 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), Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services with the UHC Nursing Home Plan NY-F003 (HMO I-SNP) partially covers hearing exams with a coinsurance of at most 20%, but does not cover routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, or over the ear), or OTC hearing aids.
Vision Services See details
Vision Services include eye exams and eyewear coverage. Routine eye exams have no copay, but a coinsurance of 0-20% may apply, while eyewear coverage includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay, with a combined maximum of $100 per year. Eyeglass frames and lenses are each limited to one per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the UHC Nursing Home Plan NY-F003 (HMO I-SNP), with a coinsurance of 0% to 20% for Medicare Dental Services, but orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. Prior authorization is required for Medicare Dental Services.
Home Infusion bundled Services See details
The UHC Nursing Home Plan NY-F003 (HMO I-SNP) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the UHC Nursing Home Plan NY-F003 (HMO I-SNP) and require 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, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 0-20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a coinsurance of at most 20% and Lab Services with no copay, as well as coverage for Diagnostic Radiological Services and Therapeutic Radiological Services with a coinsurance of at most 20%, and Outpatient X-Ray Services with no copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the UHC Nursing Home Plan NY-F003 (HMO I-SNP) with no copay and no coinsurance, but 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-F003 (HMO I-SNP). This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Nursing Home Plan NY-F003 (HMO I-SNP) with prior authorization required. For days 1-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services are not covered by the UHC Nursing Home Plan NY-F003 (HMO I-SNP), including acupuncture, over-the-counter items, meal benefits, and many other services. No authorization or referral is required for these services.
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