UHC Nursing Home Plan GA-F001 (I-SNP) Plan Details for Dooly County, GA
CMS rated this UnitedHealthcare plan (H0710-033-0) 5.0 stars (Excellent), making it a top-rated plan from this insurance company.
UHC Nursing Home Plan GA-F001 (I-SNP PPO) is a Medicare Advantage Special Needs Plan. Enroll for 2025 starting Oct 15. Get notified.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all qualification requirements for eligibility to join this PPO I-SNP plan.
2025 UHC Nursing Home Plan GA-F001 Cost and Coverage Notification
The 2025 cost and coverage information for UHC Nursing Home Plan GA-F001 will not be available until early October. We'll notify you when it is available from CMS.
Sign-Up for 2025 Medicare Plan Notification. The 2025 enrollment period begins October 15.
Plan Basics | |
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Plan ID: | H0710-033-0 |
Plan Type: | PPO |
Plan Year: | 2024 |
Premium: | $34.90/mo Plus your Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | /yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Basic $545.00 deductible |
Supplemental Benefits: | Dental, Vision, Hearing |
Availability: | Dooly County, GA |
Insured By: | UnitedHealthcare |
Summary of Benefits |
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Health Plan Cost Sharing & Benefits
UHC Nursing Home Plan GA-F001 is a Preferred Provider Organization (PPO) plan. PPO I-SNP plan members usually use in-network healthcare providers but can go out of network when necessary. However, visits to non-network providers may cost more.
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 |
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Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | 20% Coinsurance Prior Authorization Required |
Wellness programs (e.g., fitness, nursing hotline): | |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | 20% Coinsurance Prior Authorization Required |
Routine foot care: | $0 Copay Prior Authorization Required |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | 20% Coinsurance Prior Authorization Required |
Routine chiropractic care: | $0 |
Emergency Care / Urgent Care | |
Emergency room care: | $100 Copay |
Urgent care: | $40 Copay |
Ground ambulance: | 20% Coinsurance |
Inpatient hospital coverage: | $1,628.00 per stay |
Outpatient hospital coverage: | 20% Coinsurance Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 100 |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | 20% Coinsurance |
Outpatient group therapy visit with a psychiatrist: | 20% Coinsurance |
Inpatient hospital - psychiatric: | $1,628.00 per stay |
Outpatient group therapy visit: | 20% Coinsurance |
Outpatient individual therapy visit: | 20% Coinsurance Prior Authorization Required |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $0 Copay Prior Authorization Required |
Occupational therapy visit: | $0 Copay Prior Authorization Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | 20% Coinsurance Prior Authorization Required |
Lab services: | $0 Copay Prior Authorization Required |
Outpatient x-rays: | $0 Copay Prior Authorization Required |
Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our UHC Nursing Home Plan GA-F001 Summary of Benefits information.
Supplemental Health Plan Benefits (H0710-033-0)
The following is a summary of the supplemental benefits UnitedHealthcare includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | Maximum dental benefit: | $2,250.00 Every year |
Oral exam (In-Network) | Covered |
Fluoride treatment (In-Network) | Covered |
Dental x-ray(s) (In-Network) | Covered |
Cleaning (In-Network) | Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Covered |
Non-routine services (In-Network) | Covered |
Diagnostic services (In-Network) | Covered |
Extractions (In-Network) | Covered |
Endodontics (In-Network) | Covered |
Restorative services (In-Network) | Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Covered |
Hearing | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Not Covered |
Vision | Maximum vision benefit: | $200.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay Prior Authorization Required |
Contact lenses (In-Network) | $0 Copay |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
UHC Nursing Home Plan GA-F001 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.
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 details of this plan's prescription drug plan premium.
Basic Part D Premium: | $34.90 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $34.90 |
Part D Premium with Full LIS Assistance: | $0.00 |
The Social Security Extra Help page has more information about the low-income subsidy (LIS) and how to enroll in the program.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $545.00. 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, UHC Nursing Home Plan GA-F001 has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
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$0 copay on all covered generic and brand-name prescriptions. |
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage I-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will help you understand the quality of care and service you can expect if you join this UnitedHealthcare plan.
CMS Measure | Star Rating |
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2024 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
UHC Nursing Home Plan GA-F001
To be eligible to enroll in UHC Nursing Home Plan GA-F001, you must meet three requirements:
- You are eligible for Medicare;
- You live in Dooly 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 UHC Nursing Home Plan GA-F001, 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:
- None.
Contact UnitedHealthcare
Plan Website: | http://UHC.com/Medicare |
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Formulay Information: | http://UHC.com/Medicare |
Pharmacy Information: | UnitedHealthcare Pharmacy Page |
Prospective Members: | (888)834-3721 |
TTY Users: | 711 |
If you qualify for Medicare benefits 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.
Health Plan Compatibility
Special Needs Plans (SNPs) under Medicare Advantage typically do not work with other types of health insurance. If you have Medicare Part A or Part B and decide to join an SNP plan, you will be removed from Original Medicare. Furthermore, you cannot be enrolled in an SNP plan and hold Medicare Supplement Insurance at the same time.
Members of a D-SNP maintain their current Medicaid plan and Medicaid benefits. Veterans with VA Health Benefits might have the option to receive care at a nearby VA hospital.
Citations & References
- UnitedHealthcare, http://UHC.com/Medicare, Last Accessed October 13, 2023
- Medicaid.gov, "Medicaid & CHIP in Georgia", Last Accessed January 4, 2024
- CMS.gov, "Institutional Special Needs Plans (I-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed January 3, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.