2027 Medicare Advantage plan
UHC Nursing Home Plan AZ-F001 (PPO I-SNP): 2027 benefits and costs
UnitedHealthcare PPO I-SNP Special Needs Plan
CMS plan ID: H0710-005-0 · Plan year: 2027
UHC Nursing Home Plan AZ-F001 (PPO I-SNP) is a 2027 Medicare Advantage plan offered by UnitedHealthcare. It is listed in Arizona.
2027 plan costs at a glance
- Organization
- UnitedHealthcare
- Plan organization
- CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.
- Parent company
- UnitedHealth Group, Inc.
- Plan type
- PPO I-SNP
- Part C premium
- $0.00
- Part D premium
- $9.40
- Prescription drug coverage
- Yes
- Special Needs Plan type
- Institutional
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- $260.00
Applies to out-of-network Medicare-covered services and certain in-network Medicare-covered services; out-of-network $0 preventive care is exempt.
- In-network medical maximum
- $9,850.00
- Combined in/out-of-network medical maximum
- $14,800.00
- Out-of-network medical maximum
- Not applicable
Who can join this Special Needs Plan?
This plan has institutional care eligibility requirements. The plan must confirm your qualifying care needs or living situation before you enroll.
- Plan eligibility type
- Institutional
- Institutional plan type
- Facility-based Institutional special needs plan (FI-SNP)
2027 benefit summary
Doctor visits and medical care
Plan-level deductibles may still apply when a service-specific deductible is listed as No.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | 0% to 20% coinsurance
| 30% coinsurance
| |
| Specialist visit | $0.00 copay
| 30% coinsurance
|
|
| Emergency care | $115.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $0.00 to $40.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0.00 copay
| 30% coinsurance
|
|
| Dialysis | 20% coinsurance
| 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 30% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 0% to 30% coinsurance
|
|
| Kidney disease education services | $0.00 copay
| 30% coinsurance
|
|
| Medicare-covered chiropractic | 20% coinsurance
| 30% coinsurance
|
|
| Medicare-covered foot care | $0.00 copay
| 30% coinsurance
|
|
| Other health professionals | $0.00 copay
| 30% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–34: $75.00 copay per day Days 35–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–34: $75.00 copay per day Days 35–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–100: $0.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | 0% to 20% coinsurance
| 30% coinsurance
| |
| Hospital observation services | 20% coinsurance
| 30% coinsurance
| |
| Ambulatory surgical center | 0% to 20% coinsurance
| 30% coinsurance
|
|
| Outpatient blood | 20% coinsurance
| 30% coinsurance
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0.00 copay
| 30% coinsurance
|
|
| Laboratory services | $0.00 copay
| $0.00 copay
|
|
| Diagnostic radiology (CT, MRI) | 0% to 20% coinsurance
| 30% coinsurance
|
|
| Therapeutic radiology | $0.00 copay
| 30% coinsurance
|
|
| X-rays | $0.00 copay
| 30% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $0.00 copay
| 30% coinsurance
|
|
| Intensive outpatient program | $0.00 copay
| 30% coinsurance
|
|
| Substance use treatment, individual sessions | 0% to 20% coinsurance
| 30% coinsurance
|
|
| Substance use treatment, group sessions | 20% coinsurance
| 30% coinsurance
|
|
| Opioid treatment program | $0.00 copay
| $0.00 copay
|
|
| Mental health, individual sessions | 0% to 20% coinsurance
| 30% coinsurance
|
|
| Mental health, group sessions | 20% coinsurance
| 30% coinsurance
|
|
| Psychiatry, individual sessions | 0% to 20% coinsurance
| 30% coinsurance
|
|
| Psychiatry, group sessions | 20% coinsurance
| 30% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $0.00 copay
| 30% coinsurance
|
|
| Physical and speech therapy | $0.00 copay
| 30% coinsurance
|
|
| Cardiac rehabilitation | 20% coinsurance
| 30% coinsurance
|
|
| Intensive cardiac rehabilitation | 20% coinsurance
| 30% coinsurance
|
|
| Pulmonary rehabilitation | 20% coinsurance
| 30% coinsurance
|
|
| Supervised exercise for peripheral artery disease | 20% coinsurance
| 30% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $0.00 copay
| $0.00 copay
|
|
| Air ambulance | $0.00 copay
| $0.00 copay
|
|
| Durable medical equipment | $0.00 copay
| 30% coinsurance
|
|
| Prosthetic devices | $0.00 copay
| 30% coinsurance
|
|
| Medical supplies | $0.00 copay
| 30% coinsurance
|
|
| Diabetic supplies | $0.00 copay
| 30% coinsurance
|
|
| Diabetic shoes and inserts | $0.00 copay
| 30% coinsurance
|
|
| Diabetic monitors | $0.00 copay
| 30% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | 20% coinsurance | 30% coinsurance
| |
| Oral examsAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Dental X-raysAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Dental cleaningAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| FluorideAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Other preventive dentalAdditional plan benefit | $0.00 copay | $0.00 copay
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | 20% coinsurance
| 30% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0.00 copay | 30% coinsurance
|
|
| Medicare-covered eyewear | $0.00 copay
| $0.00 copay
|
|
| Contact lensesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | 20% coinsurance
| 30% coinsurance
|
|
| Routine hearing examsAdditional plan benefit | $0.00 copay | 30% coinsurance
|
|
| Prescription hearing aids (all types)Additional plan benefit | $0.00 copay
| $0.00 copay
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0.00 copay
| 90% coinsurance
| |
| Annual physical examAdditional plan benefit | $0.00 copay
| 30% coinsurance
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Podiatry Services - Routine Foot CareAdditional plan benefit | Out-of-network | 30% coinsurance
|
|
| Transportation to plan-approved health locationsAdditional plan benefit | Out-of-network | 75% coinsurance
|
|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | 0% to 30% coinsurance
| |
| Home and Bathroom Safety Devices and ModificationsAdditional plan benefit | Out-of-network | 90% coinsurance
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | 30% coinsurance
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | 30% coinsurance
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | 30% coinsurance
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | 30% coinsurance
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | 30% coinsurance
|
Allowances and optional benefits
Combined Benefit 1
One shared limit covers the listed services, not a separate allowance for each service.
- Services sharing this allowance
- Over-the-counter health items; Home and Bathroom Safety Devices and Modifications
- How benefits are provided
- Catalogue Purchase; Debit Card
- Advance choice of benefits required
- No
- Shared benefit limit
- $235.00
- How often this limit applies
- Every three months
- Shared limit on visits or trips
- No
Prescription drug coverage
Costs shown are for initial coverage.
This plan uses a non-tiered standard drug benefit; individual drug prices are not listed here.
| Pharmacy | Supply |
|---|---|
| Standard retail | 30 days |
| Standard retail | 100 days |
| Standard mail order | 30 days |
| Standard mail order | 100 days |
| Out-of-network pharmacy | 30 days |
| Long-term care pharmacy | 31 days |
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.