UnitedHealthcare Nursing Home Plan (I-SNP PPO), Maricopa County, AZ
UnitedHealthcare Nursing Home Plan (Plan ID: H0710-005) is a 2023 Medicare Special Needs Plan (I-SNP) for people who live in Maricopa County, Arizona. This UnitedHealthcare PPO plan is required to provide all of the same benefits as Original Medicare and includes some additional benefits, but out-of-pocket costs may be different.
CMS rated this plan 5.0 (Excellent) out of 5 stars.
GET NOTIFIED: 2024 Medicare Special Needs Plan Notification.
What You Need to Know
- UnitedHealthcare Nursing Home Plan is a private PPO health plan for people who are institutionalized.
- This plan is for individuals living in a long-term care facility.
- If you qualify and enroll, this PPO plan replaces your Original Medicare coverage and offers the same benefits as Medicare Part A and Part B.
- To qualify, you must have Medicare Part A and Part B, live in the plan's service area, and live in an institution (like a nursing home) or require nursing care at home.
- This UnitedHealthcare plan includes Medicare Part D prescription drug coverage and other benefits not covered by Original Medicare.
- The annual Part D deductible is $505.00. You pay this amount before cost-sharing begins.
- If you qualify for the Social Security "Extra Help" program, you can get financial assistance to help pay your Medicare Part D monthly premium, annual deductible, and prescription copayments.
- If you don't qualify to join an SNP plan like this one, you can compare Maricopa County, Arizona Medicare Advantage plans.
- 2024 costs and benefits for UnitedHealthcare Nursing Home Plan will be available in early October. Get Notification.
| H0710-005-0 Plan Basics | |
|---|---|
| Plan ID: | H0710-005-0 |
| Plan Type: | I-SNP |
| Network Type: | PPO |
| Plan Year: | 2023 |
| Premium: | $42.60/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $5,100 In and Out-of-network $1,500 In-network |
| Drug Plan Benefit: | Basic $505.00 deductible |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | Maricopa County, AZ |
| Insured By: | UnitedHealthcare |
Health Plan Costs & Benefits
UnitedHealthcare Nursing Home Plan is a Preferred Provider Organization (PPO) plan. PPO plan members usually use in-network healthcare providers but can go out of network when necessary. However, visits to non-network providers could cost significantly more.
Premiums, deductibles, and copays vary widely from plan to plan. It is very important to compare costs and apply them to your personal financial and healthcare needs.
Monthly Premium
UnitedHealthcare Nursing Home Plan's total monthly premium in Maricopa County is $42.60. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
Annual Deductible
UnitedHealthcare Nursing Home Plan's annual health plan deductible is $0.00. This does not include the deductible for the prescription drug plan (if any), which is detailed below.
Maximum Out-of-Pocket Limit
The Maximum Out-of-Pocket (MOOP) with this UnitedHealthcare plan is $5,100 in and out-of-network $1,500 in-network. Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket (MOOP) limit on inpatient and outpatient healthcare services. Once you reach this amount of spending on your copayments, all of your Medicare Part A and Part B services will be covered at no additional charge for the remainder of the year. MOOP does not include monthly premiums, prescriptions, or other extra benefits.
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this UnitedHealthcare plan:
| Healthcare Service | Member Cost |
|---|---|
| Health plan deductible | $0 |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $5,100 In and Out-of-network $1,500 In-network |
| Doctor Visits | |
| Specialist (In-Network) | 0-20% coinsurance per visit (authorization required) |
| Specialist (Out-of-Net) | 30% coinsurance per visit (authorization required) |
| Primary (Out-of-Net) | 30% coinsurance per visit |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Outpatient group therapy visit (In-Network) | 0-20% coinsurance (authorization required) |
| Outpatient group therapy visit with a psychiatrist (In-Network) | 0-20% coinsurance (authorization required) |
| Inpatient hospital - psychiatric (In-Network) | $75 per day for days 1 through 34 $0 per day for days 35 through 90 (authorization required) |
| Inpatient hospital - psychiatric (Out-of-Net) | 30% per stay (authorization required) |
| Outpatient individual therapy visit with a psychiatrist (In-Network) | 0-20% coinsurance (authorization required) |
| Outpatient individual therapy visit with a psychiatrist (Out-of-Net) | 30% coinsurance (authorization required) |
| Outpatient group therapy visit (Out-of-Net) | 30% coinsurance (authorization required) |
| Outpatient group therapy visit with a psychiatrist (Out-of-Net) | 30% coinsurance (authorization required) |
| Outpatient individual therapy visit (In-Network) | 0-20% coinsurance (authorization required) |
| Rehabilitation Services | |
| Physical therapy and speech and language therapy visit (In-Network) | $0 copay (authorization required) |
| Occupational therapy visit (In-Network) | $0 copay (authorization required) |
| Occupational therapy visit (Out-of-Net) | 30% coinsurance (authorization required) |
| Medical Equipment / Supplies | |
| Prosthetics (e.g., braces, artificial limbs) (In-Network) | 0-20% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen) (Out-of-Net) | 30% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen) (In-Network) | 20% coinsurance per item (authorization required) |
| Diabetes supplies (Out-of-Net) | 30% coinsurance per item (authorization required) |
| Diabetes supplies (In-Network) | 20% coinsurance per item (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Diagnostic tests and procedures (In-Network) | 0-20% coinsurance (authorization required) |
| Outpatient x-rays (In-Network) | $0 copay (authorization required) |
| Diagnostic radiology services (e.g., MRI) (Out-of-Net) | 30% coinsurance (authorization required) |
| Diagnostic radiology services (e.g., MRI) (In-Network) | 0-20% coinsurance (authorization required) |
| Diagnostic tests and procedures (Out-of-Net) | 30% coinsurance (authorization required) |
| Lab services (In-Network) | $0 copay (authorization required) |
| Outpatient x-rays (Out-of-Net) | 30% coinsurance (authorization required) |
| Medicare Part B Drugs | |
| Other Part B drugs (In-Network) | 0-20% coinsurance (authorization required) |
| Other Part B drugs (Out-of-Net) | 0-30% coinsurance (authorization required) |
| Chemotherapy (In-Network) | 20% coinsurance (authorization required) |
| Foot Care (podiatry Services) | |
| Foot exams and treatment (Out-of-Net) | 30% coinsurance (authorization required) |
| Routine foot care (In-Network) | $0 copay (authorization required, limits may apply) |
| Routine foot care (Out-of-Net) | 30% coinsurance (authorization required, limits may apply) |
| Hearing | |
| Hearing aids (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Hearing exam (In-Network) | 0-20% coinsurance (authorization required) |
| Fitting/evaluation | Not covered |
| Hearing aids (In-Network) | $0 copay (authorization required, limits may apply) |
| Preventive Dental | |
| Dental x-ray(s) (In-Network) | $0 copay (limits may apply) |
| Cleaning (Out-of-Net) | $0 copay (limits may apply) |
| Cleaning (In-Network) | $0 copay (limits may apply) |
| Dental x-ray(s) (Out-of-Net) | $0 copay (limits may apply) |
| Oral exam (Out-of-Net) | $0 copay (limits may apply) |
| Fluoride treatment (Out-of-Net) | $0 copay (limits may apply) |
| Oral exam (In-Network) | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | $0 copay (authorization required, limits may apply) |
| Extractions (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Diagnostic services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Diagnostic services (In-Network) | $0 copay (authorization required, limits may apply) |
| Restorative services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Endodontics (In-Network) | $0 copay (authorization required, limits may apply) |
| Periodontics (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Restorative services (In-Network) | $0 copay (authorization required, limits may apply) |
| Endodontics (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Extractions (In-Network) | $0 copay (authorization required, limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Non-routine services (In-Network) | $0 copay (authorization required, limits may apply) |
| Periodontics (In-Network) | $0 copay (authorization required, limits may apply) |
| Vision | |
| Other | Not covered |
| Upgrades | Not covered |
| Routine eye exam (Out-of-Net) | 30% coinsurance (authorization required, limits may apply) |
| Eyeglasses (frames and lenses) (In-Network) | $0 copay (limits may apply) |
| Contact lenses (Out-of-Net) | $0 copay (limits may apply) |
| Contact lenses (In-Network) | $0 copay (limits may apply) |
| Routine eye exam (In-Network) | $0 copay (authorization required, limits may apply) |
| Eyeglasses (frames and lenses) (Out-of-Net) | $0 copay (limits may apply) |
| Eyeglass frames | Not covered |
| Emergency Care / Urgent Care | |
| Urgent care | $40 copay per visit (always covered) |
| Ground ambulance | 20% coinsurance |
| Inpatient hospital coverage | 30% per stay |
| Outpatient hospital coverage | $0 copay |
| Skilled Nursing Facility | $0 per day for days 1 through 100 |
| Optional supplemental benefits | No |
Feel free to download our UnitedHealthcare Nursing Home Plan Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
UnitedHealthcare Nursing Home Plan includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Basic plans typically have less cost-sharing by the plan than plans with an enhanced benefit. But, close to a third of all enhanced plans charge more than the average for preferred brand name drugs, and over 50% charge more for non-preferred brand drugs. For most people, a basic plan is their best bet, due to lower premiums and lower cost-sharing, even if the plan has a deductible.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $42.60 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $42.60 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $10.60 |
| Part D Premium with 50% LIS Assistance: | $21.30 |
| Part D Premium with 25% LIS Assistance: | $31.90 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $505.00. This is the amount you must pay at the pharmacy before UnitedHealthcare begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, UnitedHealthcare Nursing Home Plan has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Tier | Preferred | Standard |
|---|---|---|
| $0 copay on all covered generic and brand-name prescriptions. | ||
CMS Rating Marks and Our Review
Each year Medicare rates I-SNP plans, like this one, in nine major categories. These ratings are designed to help you understand the quality of care and service you can expect if you qualify and choose to join UnitedHealthcare Nursing Home Plan.
This is one of the rare 5-star Medicare Advantage I-SNP plans available in Arizona. At this time, we do not have enough information to rate how well UnitedHealthcare Nursing Home Plan does at keeping its members healthy. This plan does an excellent job (5 stars!) managing its member's chronic health conditions. We do not have enough information from this plan to rate member experience. When it comes to complaints and changes in performance, this plan gets the highest marks. The plan shines at customer service with an overall excellent mark on this important metric.
| CMS Measure | Star Rating |
|---|---|
| 2023 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
UnitedHealthcare Nursing Home Plan
To be eligible to enroll in UnitedHealthcare Nursing Home Plan, you must meet three requirements:
- You are eligible for Medicare;
- You live in Maricopa County (the plan’s service area); and
- You require the level of care provided in an institutionalized setting, such as a long-term care nursing facility, for 90 days or more.
If you live at home and require an equivalent level of skilled care, you may be eligible for an Institutional Equivalent Special Needs Plan (IE-SNP).
Before joining UnitedHealthcare Nursing Home Plan, consider these questions:
- Does the plan's provider network include my nursing home or home care provider?
- What costs should I expect with my coverage (premiums, deductibles, copayments)?
- Is there an annual limit on my out-of-pocket costs?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary?
- What special accommodations does the plan make for persons with disabilities?
- What special language and cultural accommodations does the plan make?
Additional I-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact UnitedHealthcare
Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent (Mon-Sun 8am-11pm EST) and learn more about this Special Needs Plan and other plans on this site. You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
| Plan Website: | http://www.UHCMedicareSolutions.com |
|---|---|
| Formulay Information: | http://www.UHCMedicareSolutions.com |
| Pharmacy Information: | UnitedHealthcare Pharmacy Page |
| Prospective Members: | (888)834-3721 |
| TTY Users: | (711)- |
If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.
Citations & References
- UnitedHealthcare, http://www.UHCMedicareSolutions.com, Last Accessed October 13, 2022
- Medicaid.gov, "Medicaid & CHIP in Arizona", Last Accessed January 20, 2023
- CMS.gov, "Institutional Special Needs Plans (I-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 21, 2023
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 21, 2023
- CMS.gov, Plan Benefits Package, Last Accessed January 21, 2023