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UHC Nursing Home Plan NY-F004 (HMO-POS I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Nursing Home Plan NY-F004 (HMO-POS 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-F004 (HMO-POS I-SNP) in 2025, please refer to our full plan details page.
UHC Nursing Home Plan NY-F004 (HMO-POS I-SNP) is a HMO-POS I-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Broome and Chautauqua Counties. 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-F004 (HMO-POS 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-F004 (HMO-POS 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-F004 (HMO-POS 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-F004 (HMO-POS I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.30. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $62.00. 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 Maximum Out-Of-Pocket cost of $1500.00 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-F004 (HMO-POS 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 $72.30. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00, at which point you enter the next coverage phase.
Additional Benefits
The UHC Nursing Home Plan NY-F004 (HMO-POS I-SNP) plan offers a range of benefits with varying costs. It includes coverage for inpatient hospital stays with a $1,500 copay, and outpatient services with a coinsurance between 0% and 20%. Emergency services have a $50 copay, and primary care services like primary care physician visits and physical therapy have no copay, while many other services have either no copay or a coinsurance. This plan provides additional benefits such as no copay for home health services, routine hearing exams, and vision exams. Additionally, dental services, including oral exams and cleanings, are covered with no copay up to a $750 annual maximum. The plan also includes coverage for a number of other services, such as ambulance, and medical equipment, with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered for this plan, with a copay of $1,500 for a Medicare-covered stay. Additional days, non-Medicare-covered stays, and upgrades for 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 between 0% and 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%, and Outpatient Blood Services with a coinsurance between 0% and 20%. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services under the UHC Nursing Home Plan NY-F004 (HMO-POS I-SNP) plan include a $50 copay, and no coinsurance. Urgently Needed Services have 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-F004 (HMO-POS I-SNP) plan offers primary care, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physical therapy, speech-language pathology services, and additional telehealth benefits have no copay. Chiropractic services, physician specialist services, mental health specialty services, podiatry services, and psychiatric services have a coinsurance between 0% and 20%. Other health care professional, and opioid treatment program services have no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional services including glaucoma screening 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, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with no copay and at most 20% coinsurance, and prescription hearing aids (all types) with no copay. OTC hearing aids are 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 eye exams and eyewear. Routine eye exams have no copay and a coinsurance between 0% and 20%, with one exam covered every year. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay; however, eyeglass frames and lenses are limited to one per year and have a combined maximum benefit of $150. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with 0% - 20% coinsurance, and other dental services including 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 all with no copay, and a maximum plan benefit of $750 per year. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B insulin drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the UHC Nursing Home Plan NY-F004 (HMO-POS I-SNP) plan, but require prior authorization. There is no copay, and coinsurance ranges from 0% to 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 0-20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are also covered with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The UHC Nursing Home Plan NY-F004 (HMO-POS I-SNP) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with a coinsurance of at most 20%, Lab Services with no copay, Diagnostic Radiological Services with a coinsurance of at most 20%, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with no copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered under the UHC Nursing Home Plan NY-F004 (HMO-POS 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 not covered by the UHC Nursing Home Plan NY-F004 (HMO-POS I-SNP). Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Nursing Home Plan NY-F004 (HMO-POS I-SNP) with no copay for days 1-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The UHC Nursing Home Plan NY-F004 (HMO-POS I-SNP) plan covers over-the-counter (OTC) items with no copay. 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 (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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