UnitedHealthcare Nursing Home Plan 1 (I-SNP PPO) A 2022 Suffolk County, New York Medicare Advantage Special Needs Plan
UnitedHealthcare Nursing Home Plan 1 is a 2022 Medicare Special Needs Plan (I-SNP) for people who live in Suffolk County, New York. This UnitedHealthcare PPO plan is required to provide all of the same benefits as Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage., and includes many additional benefits, but out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. for the member are different.
Key Takeaways
- UnitedHealthcare Nursing Home Plan 1 is a private PPO health plan for people who are institutionalized.
- This plan is for individuals living in a long-term carea variety of services that help people with their medical and non-medical needs over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including... facility.
- If you qualify and enroll, this PPO plan replaces your Original Medicare coverage and offers the same benefits as Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B.
- To qualify, you must have Medicare Part A and Part B, you must live in the plan's service area, and you must live in an institution (like a nursing home) or require nursing care at home.
- This UnitedHealthcare plan includes Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... prescription drug coverage and other benefits not covered by Original Medicare.
- The annual Part D deductible is $480.00. 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 copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service..
- If you don't qualify to join an SNP plan like this one, you can compare Suffolk County, New York Medicare Advantage plans.
| Plan Basics | |
|---|---|
| Plan ID: | H2292-002-0 |
| Plan Type: | I-SNP |
| Network Type: | PPO |
| Plan Year: | 2022 |
| Premium: | $42.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $5,100 In and Out-of-network $1,800 In-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... |
| Drug Plan Benefit: | Basic $480.00 deductible |
| Rx Gap Coverage: | No Gap Coverage |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | Suffolk County, New York |
| Insured By: | UnitedHealthcare |
Health Plan Costs & Benefits
UnitedHealthcare Nursing Home Plan 1 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.
PremiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., 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 1's total monthly premium in Suffolk County is $42.00. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above....
Annual Deductible
UnitedHealthcare Nursing Home Plan 1'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 $1,800 in-network. Unlike Original Medicare, Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). 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 $1,800 In-network |
| Doctor Visits | |
| Primary (Out-of-Net) | 30% coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. per visit |
| Primary (In-Network) | $0 copay |
| Specialist (In-Network) | 0-20% coinsurance per visit (authorization required) |
| Wellness programs (e.g., fitness, nursing hotline) | Not covered |
| Preventive care | 0-30% coinsurance |
| Mental Health Services | |
| Outpatient individual therapy visit with a psychiatrist (Out-of-Net) | 30% coinsurance (authorization required) |
| Inpatient hospital - psychiatric (In-Network) | $1,275 per stay (authorization required) |
| Inpatient hospital - psychiatric (Out-of-Net) | $1,275 per stay (authorization required) |
| 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) |
| Outpatient individual 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) |
| Outpatient group therapy visit (Out-of-Net) | 30% coinsurance (authorization required) |
| Rehabilitation Services | |
| Physical therapy and speech and language therapy visit (Out-of-Net) | 30% coinsurance (authorization required) |
| Occupational therapy visit (Out-of-Net) | 30% coinsurance (authorization required) |
| Occupational therapy visit (In-Network) | $0 copay (authorization required) |
| Medical Equipment / Supplies | |
| Durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds. (e.g., wheelchairs, oxygen) (In-Network) | 20% coinsurance per item (authorization required) |
| Diabetes supplies (In-Network) | 20% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen) (Out-of-Net) | 30% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs) (In-Network) | 0-20% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs) (Out-of-Net) | 30% 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) |
| Lab services (In-Network) | $0 copay (authorization required) |
| Diagnostic radiology services (e.g., MRI) (In-Network) | 0-20% coinsurance (authorization required) |
| Lab services (Out-of-Net) | $0 copay (authorization required) |
| Outpatient x-rays (Out-of-Net) | 30% coinsurance (authorization required) |
| Diagnostic radiology services (e.g., MRI) (Out-of-Net) | 30% coinsurance (authorization required) |
| Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. 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 (In-Network) | 0-20% coinsurance (authorization required) |
| Foot exams and treatment (Out-of-Net) | 30% coinsurance (authorization required) |
| Routine foot care (In-Network) | $0 copay (authorization required, limits may apply) |
| Hearing | |
| Fitting/evaluation | Not covered |
| Hearing aids (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Hearing aids (In-Network) | $0 copay (authorization required, limits may apply) |
| Hearing exam (Out-of-Net) | 30% coinsurance (authorization required) |
| Preventive Dental | |
| Oral exam (In-Network) | $0 copay (limits may apply) |
| Cleaning (Out-of-Net) | $0 copay (limits may apply) |
| Fluoride treatment | Not covered |
| Dental x-ray(s) (In-Network) | $0 copay (limits may apply) |
| Dental x-ray(s) (Out-of-Net) | $0 copay (limits may apply) |
| Cleaning (In-Network) | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Periodontics (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Restorative services (In-Network) | $0 copay (authorization required, limits may apply) |
| Endodontics (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) |
| Diagnostic services | Not covered |
| Non-routine services | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other 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) |
| Restorative services (Out-of-Net) | $0 copay (authorization required, limits may apply) |
| Periodontics (In-Network) | $0 copay (authorization required, limits may apply) |
| Vision | |
| Eyeglasses (frames and lenses) (In-Network) | $0 copay (limits may apply) |
| Contact lenses (In-Network) | $0 copay (limits may apply) |
| Upgrades | Not covered |
| Routine eye exam (In-Network) | $0 copay (authorization required, limits may apply) |
| Routine eye exam (Out-of-Net) | 30% coinsurance (authorization required, limits may apply) |
| Contact lenses (Out-of-Net) | $0 copay (limits may apply) |
| Eyeglass frames | Not covered |
| Other | Not covered |
| Eyeglass lenses | Not covered |
| Emergency Care / Urgent Care | |
| Emergency | $70 copay per visit (always covered) |
| Ground ambulance | 20% coinsurance |
| Inpatient hospital coverage | $1,275 per stay |
| Outpatient hospital coverage | 0-20% coinsurance per visit |
| Skilled Nursing Facility | 30% per stay |
| Optional supplemental benefits | No |
Feel free to download our UnitedHealthcare Nursing Home Plan 1 Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
UnitedHealthcare Nursing Home Plan 1 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 ServicesThe Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs., 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 subsidySocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $42.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $42.00 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $10.50 |
| Part D Premium with 50% LIS Assistance: | $21.00 |
| Part D Premium with 25% LIS Assistance: | $31.50 |
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 $480.00. 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 1 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. | ||
A Brief Review and CMS 5-Star Rating Marks
The table below shows the quality ratings for this UnitedHealthcare plan. Each year CMS rates Medicare Special Needs Plans in nine broad categories. We do not recommend joining a plan with an overall rating of less than 3.0 (3 stars).
Here's why this private I-SNP plan exceeds most expectations. Staying healthy is the best way to save money on health care, and in MedicareWire's judgement, UnitedHealthcare Nursing Home Plan 1 does a good job keeping its Suffolk County members in top health through preventive care, including screenings, tests, and vaccines. 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 |
|---|---|
| 2022 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| 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 1
To be eligible to enroll in UnitedHealthcare Nursing Home Plan 1, you must meet three requirements:
- You are eligible for Medicare;
- You live in Suffolk 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 1, 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 formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.?
- What special accommodations does the plan make for persons with disabilities?
- What special language and cultural accommodations does the plan make?
Contact UnitedHealthcare
| 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.
Citations & References
- UnitedHealthcare, http://www.UHCMedicareSolutions.com, Last Accessed October 15, 2021
- MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States..gov, "Medicaid & CHIP in New York", Last Accessed June 15, 2022
- CMS.gov, "Institutional Special Needs Plans (I-SNPs)", Last Accessed June 29, 2022
- CMS.gov, Landscape Source Files, Last Accessed October 26, 2021
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 6, 2021
- CMS.gov, Plan Benefits Package, Last Accessed October 4, 2021
This Medicare Advantage SNP plan information page was last updated on .