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UHC Northern Light Health ME-0001 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Northern Light Health ME-0001 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Northern Light Health ME-0001 (HMO-POS) in 2026, please refer to our full plan details page.
UHC Northern Light Health ME-0001 (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of Maine. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that UHC Northern Light Health ME-0001 (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about UHC Northern Light Health ME-0001 (HMO-POS).
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 Northern Light Health ME-0001 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.00. 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 $440.00 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 $6700.00 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 Northern Light Health ME-0001 (HMO-POS) Medicare plan has an annual prescription drug deductible of $440. Under this plan, Tier 1 preferred generic medications have no copay for a 1-month or 3-month supply at standard pharmacies and through mail order. Tier 2 generic drugs require a $10 copay for a 1-month standard pharmacy supply, but you can save with no copay on a 3-month supply using preferred mail order. For brand-name and specialty medications, costs are determined by coinsurance. Tier 3 preferred brand drugs require a 19% coinsurance for both standard pharmacy and mail-order fills. Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 41% and 28% coinsurance respectively for a 1-month supply.
Additional Benefits
The UHC Northern Light Health ME-0001 (HMO-POS) plan offers robust medical coverage featuring no copay for primary care visits, annual physicals, and home health services. Specialist office visits carry a low copay of $0 to $40, while emergency room care requires a $130 copay which is waived if you are admitted. For inpatient hospital stays, members pay a $455 daily copay for the first few days of care and no copay for the remainder of their stay. This plan also includes valuable dental, vision, and hearing benefits to help reduce out-of-pocket expenses. Routine dental cleanings, annual eye exams, and yearly hearing tests are covered with no copay, and members receive a $300 eyewear allowance every two years. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, ensuring affordable access to essential medical supplies.
Inpatient Hospital See details
UHC Northern Light Health ME-0001 (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $455 daily copay for days 1-6 of acute stays (no copay thereafter) and days 1-5 of psychiatric stays (no copay for days 6-90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
UHC Northern Light Health ME-0001 (HMO-POS) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $455, alongside observation services with a $455 daily copay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services feature no coinsurance and copays ranging from $0 to $25.
Partial Hospitalization See details
UHC Northern Light Health ME-0001 (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services under UHC Northern Light Health ME-0001 (HMO-POS) require prior authorization and feature a $150 copay and no coinsurance for both ground and air transport. Transportation services, including trips to plan-approved or any health-related locations, are not covered.
Emergency Services See details
Emergency services are covered by UHC Northern Light Health ME-0001 (HMO-POS) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a copay ranging from $0 to $50 with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no copays and no coinsurance.
Primary Care See details
UHC Northern Light Health ME-0001 (HMO-POS) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance. Other covered services require no coinsurance, including specialists ($0 to $40 copay), physical and occupational therapy ($20 copay), and mental health sessions ($0 to $25 copay). Chiropractic services are partially covered with a $15 copay and no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
UHC Northern Light Health ME-0001 (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive benefits, such as fitness programs, health education, and personal emergency response systems, are not covered.
Hearing Services See details
Hearing services are partially covered under the UHC Northern Light Health ME-0001 (HMO-POS) plan, which includes one annual routine hearing exam with no copay, no coinsurance, and no deductible. While hearing aid fittings, evaluations, and inner, outer, or over-the-ear prescription hearing aids are not covered, the plan covers up to two prescription hearing aids per year (with a $199 to $1,249 copay and no coinsurance) and up to two OTC hearing aids per year (with a $199 to $829 copay and no coinsurance).
Vision Services See details
Vision Services are partially covered under the UHC Northern Light Health ME-0001 (HMO-POS) plan with no deductibles and no coinsurance. Covered benefits include one annual routine eye exam with no copay, and eyewear up to a $300 limit every two years (featuring no copay for contacts and frames, and a $0 to $153 copay for lenses), while other eye exam services, eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Dental Services are partially covered by UHC Northern Light Health ME-0001 (HMO-POS), offering Medicare-covered dental services with no copay and 20% coinsurance, as well as preventive services like exams, cleanings, fluoride, and x-rays with no copay and no coinsurance. Restorative, endodontic, periodontic, prosthodontic, orthodontic, implant, oral surgery, and adjunctive general services are not covered.
Home Infusion bundled Services See details
UHC Northern Light Health ME-0001 (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance of 0% to 20%, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Northern Light Health ME-0001 (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
UHC Northern Light Health ME-0001 (HMO-POS) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies feature no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Northern Light Health ME-0001 (HMO-POS) with no coinsurance, although prior authorization is required. Under this plan, there is no copay for lab and diagnostic radiological services, a $5 copay for outpatient X-rays and diagnostic procedures, and a $40 copay for therapeutic radiological services.
Home Health Services See details
UHC Northern Light Health ME-0001 (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by UHC Northern Light Health ME-0001 (HMO-POS) with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by UHC Northern Light Health ME-0001 (HMO-POS) with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not required for admission, and additional days beyond the standard 100 days are not covered.
Other Services See details
UHC Northern Light Health ME-0001 (HMO-POS) partially covers Other Services, which includes a chronic illness meal benefit with no copay and no coinsurance, subject to prior authorization. Acupuncture, over-the-counter (OTC) items, and other services are not covered under this plan.
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