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UHC Care Advantage WI-E001 (HMO-POS I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Care Advantage WI-E001 (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 Care Advantage WI-E001 (HMO-POS I-SNP) in 2025, please refer to our full plan details page.
UHC Care Advantage WI-E001 (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 Select Counties in Wisconsin. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Care Advantage WI-E001 (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 Care Advantage WI-E001 (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 Care Advantage WI-E001 (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 Care Advantage WI-E001 (HMO-POS I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.50. 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 $195.00 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 $2000.00 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 Care Advantage WI-E001 (HMO-POS I-SNP) plan has an "Enhanced Alternative" drug benefit. The plan has a deductible of $195. Once the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. In the initial coverage phase, you will pay a $12 copay for Tier 1 drugs at a standard pharmacy, a $47 copay for Tier 2 drugs at a standard pharmacy, and a $100 copay for Tier 3 drugs at any pharmacy. For Tier 4 drugs, you will pay 30% coinsurance. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The UHC Care Advantage WI-E001 (HMO-POS I-SNP) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and coverage for ambulance, emergency, and primary care services. You'll find no copays for many services like preventive care, hearing and vision exams, dental cleanings, and home health. This plan also includes coverage for hearing aids, eyewear, and dental services with no copays for many services. Additionally, you'll have access to services like home infusion, dialysis, and medical equipment with copays or coinsurance, as well as transportation to health-related locations and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $200 copay for days 1-7, and no copay for days 8-90, while Additional Days have no copay. Inpatient Hospital Psychiatric has a $200 copay for days 1-7, and no copay for days 8-90. Non-Medicare-covered stays and upgrades are not covered for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays are not covered for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient hospital services have a copay between $0 and $175, and observation services have a $175 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Individual Sessions for Outpatient Substance Abuse have a copay between $0 and $25, and Group Sessions for Outpatient Substance Abuse have a $15 copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 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 $100 copay, and transportation services to plan-approved health-related locations with no copay for up to 36 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the UHC Care Advantage WI-E001 (HMO-POS I-SNP) plan. Emergency Services have a $90 copay, while Urgently Needed Services have a copay between $0 and $40. Worldwide Emergency Services include Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, all with no copay.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a copay of $0-$15, Physician Specialist Services with a copay of $0-$15, Mental Health Specialty Services with a copay of $0-$25 for individual sessions and $15 for group sessions, Podiatry Services with no copay, Other Health Care Professional services with a copay of $0-$15, Psychiatric Services with a copay of $0-$25 for individual sessions and $15 for group sessions, Physical Therapy and Speech-Language Pathology Services with a copay of $0-$15, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and an annual physical exam with no copay. Additional preventive services are covered, including Home and Bathroom Safety Devices and Modifications with no copay, and Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. 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 for up to one exam per year, while fitting/evaluation for hearing aids is not covered. Prescription Hearing Aids (all types) have no copay for up to two hearing aids per year, and the plan covers a maximum of $2200 per year for hearing aids. OTC hearing aids have no copay for two hearing aids per year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and include routine eye exams. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames with no copay, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Care Advantage WI-E001 (HMO-POS I-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Medicare dental services have a 20% coinsurance, while other dental services are subject to a $2,400 annual maximum. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the UHC Care Advantage WI-E001 (HMO-POS I-SNP) plan, with a $35 copay for Medicare Part B Insulin Drugs and a coinsurance between 0% and 20% for all services. Prior authorization is required for coverage.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance with authorization required, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies has a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, 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 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 Care Advantage WI-E001 (HMO-POS I-SNP) plan 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 the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required, and there is a copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Care Advantage WI-E001 (HMO-POS I-SNP) plan, with no copay for days 1-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for the UHC Care Advantage WI-E001 (HMO-POS I-SNP) plan covers over-the-counter items with no copay, but acupuncture, meal benefits, and other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and personal care services are not covered.
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