UHC Care Advantage MN-E001 (PPO I-SNP)

Minnesota Institutional Special Needs I-SNP Plan (2024 Plan)


Monthly Premium

Your Cost
$42
by UnitedHealthcare

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 5.0
out of 5 stars

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Plan Name
UHC Care Advantage MN-E001 (PPO I-SNP)
Insurance Carrier
UnitedHealthcare
Plan Type
Institutional Special Needs Plan (I-SNP)
Network Type
PPO

UHC Care Advantage MN-E001 (PPO I-SNP) is a Institutional Special Needs Plan (I-SNP), which is available in Minnesota and offered by the health insurance company UnitedHealthcare. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$42
Annual Deductible
$0
Max Out-of-Pocket
$1,600
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$90 copay per visit (always covered)
Ambulance
$100 copay

UHC Care Advantage MN-E001 (PPO I-SNP) has a monthly premium cost of $42 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,100 In and Out-of-network $1,600 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for UHC Care Advantage MN-E001 (PPO I-SNP) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

UHC Care Advantage MN-E001 (PPO I-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. UHC Care Advantage MN-E001 (PPO I-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. UHC Care Advantage MN-E001 (PPO I-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Not covered
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Limited coverage
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Not covered

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, UHC Care Advantage (PPO I-SNP) received an overall government quality rating of 5.0 stars out of 5 stars.

UHC Care Advantage (PPO I-SNP) performed better than Minnesota’s State average overall quality score of 4.2 stars.

This Plan’s 5-star Gov’t Quality Score
Minnesota State Average Score
Overall Government 5 Star Quality Rating
 5.0
 4.2
Summary rating of health plan quality
 5
 4.0
Staying healthy: screenings, tests, & vaccines
No Rating (new plan)
 4.0
Managing chronic (long term) conditions
 5
 3.3
Member experience with health plan
No Rating (new plan)
 4.1
Member complaints & changes in the health plan's performance
 5
 4.0
Health plan customer service
 4
 4.5
Summary rating of drug plan quality
 5
 4.3
Drug plan customer service
 4
 4.2
Member complaints & changes in the drug plan's performance
 5
 4.4
Member experience with the drug plan
No Rating (new plan)
 3.6
Drug safety & accuracy of drug pricing
 5
 4.0

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

UHC Care Advantage (PPO I-SNP) received 5 stars for its health plan quality score which is better than the Minnesota State average health plan quality score of 4.0 stars.

UHC Care Advantage (PPO I-SNP) received 5 stars for its drug plan quality score which is better than the Minnesota State average drug plan quality score of 4.3 stars.


Monthly Premium
$42
Health Portion of Premium
$0
Drug Portion of Premium
$42
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$5,100 In and Out-of-network
$1,600 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: 30% coinsurance per visit
Specialist visit
In-network: $0 copay
Out-of-network: 30% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Outpatient x-rays
In-network: $0 copay
Out-of-network: 30% coinsurance
Emergency care
$90 copay per visit (always covered)
Urgent care
$0-40 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $200 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 91 and beyond
Out-of-network: 30% per stay
Outpatient hospital coverage
In-network: $0-175 copay per visit
Out-of-network: 30% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 100
Out-of-network: 30% per stay

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: 0-30% coinsurance

Ambulance

Ground ambulance
In-network: $100 copay
Out-of-network: $100 copay

Therapy services

Occupational therapy visit
In-network: $0 copay
Out-of-network: 30% coinsurance
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: 30% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $15 copay
Out-of-network: 30% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: $0-25 copay
Out-of-network: 30% coinsurance
Outpatient group therapy visit
In-network: $15 copay
Out-of-network: 30% coinsurance
Outpatient individual therapy visit
In-network: $0-25 copay
Out-of-network: 30% coinsurance

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 0-20% coinsurance per item
Out-of-network: 30% coinsurance per item
Diabetes supplies
In-network: $0 copay per item
Out-of-network: 30% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$2.00 copay$0 copay
Generic$12.00 copay$12.00 copay$0 copay
Preferred Brand$47.00 copay$0 copay
Non-Preferred Drug$100.00 copay$0 copay
Specialty Tier33%$0 copay
1 * The above cost-sharing only applies to some drugs on this tier. For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 0-30% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 0-30% coinsurance

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: 30% coinsurance
Fitting/evaluation
Not covered
Hearing aids - All types
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Non-routine services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic services
In-network: $0 copay
Out-of-network: $0 copay
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Extractions
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: 30% coinsurance
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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