I-SNP Plan Costs & Benefits

UnitedHealthcare Nursing Home Plan 2 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.

Private health plans are not standardized. Out-of-pocket costs, including premiums, deductibles, and copays, widely vary. We recommend reviewing and comparing plan costs carefully.

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
Specialist (Out-of-Net)	30% coinsurance per visit (authorization required)
Specialist (In-Network)	0-20% coinsurance per visit (authorization required)
Primary (Out-of-Net)	30% coinsurance per visit
Wellness programs (e.g., fitness, nursing hotline)	Covered
Preventive care	0-30% coinsurance
Mental Health Services
Inpatient hospital - psychiatric (In-Network)	$1,556 per stay (authorization required)
Outpatient group therapy visit (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 (In-Network)	0-20% coinsurance (authorization required)
Outpatient group therapy visit with a psychiatrist (Out-of-Net)	30% coinsurance (authorization required)
Outpatient individual therapy visit with a psychiatrist (In-Network)	0-20% 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)
Inpatient hospital - psychiatric (Out-of-Net)	$1,556 per stay (authorization required)
Rehabilitation Services
Occupational therapy visit (In-Network)	$0 copay (authorization required)
Occupational therapy visit (Out-of-Net)	30% coinsurance (authorization required)
Physical therapy and speech and language therapy visit (In-Network)	$0 copay (authorization required)
Medical Equipment / Supplies
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)
Diabetes supplies (Out-of-Net)	30% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen) (In-Network)	20% coinsurance per item (authorization required)
Diagnostic Procedures / Lab Services / Imaging
Diagnostic radiology services (e.g., MRI) (Out-of-Net)	30% coinsurance (authorization required)
Lab services (Out-of-Net)	$0 copay (authorization required)
Diagnostic radiology services (e.g., MRI) (In-Network)	0-20% coinsurance (authorization required)
Lab services (In-Network)	$0 copay (authorization required)
Diagnostic tests and procedures (Out-of-Net)	30% coinsurance (authorization required)
Diagnostic tests and procedures (In-Network)	0-20% coinsurance (authorization required)
Outpatient x-rays (In-Network)	$0 copay (authorization required)
Medicare Part B Drugs
Chemotherapy (In-Network)	20% coinsurance (authorization required)
Other Part B drugs (Out-of-Net)	0-30% coinsurance (authorization required)
Chemotherapy (Out-of-Net)	0-30% coinsurance (authorization required)
Foot Care (podiatry Services)
Routine foot care (Out-of-Net)	30% coinsurance (authorization required, limits may apply)
Foot exams and treatment (In-Network)	0-20% coinsurance (authorization required)
Foot exams and treatment (Out-of-Net)	30% coinsurance (authorization required)
Hearing
Hearing exam (In-Network)	0-20% coinsurance (authorization required)
Fitting/evaluation	Not covered
Hearing exam (Out-of-Net)	30% coinsurance (authorization required)
Hearing aids (Out-of-Net)	$0 copay (authorization required, limits may apply)
Preventive Dental
Fluoride treatment (In-Network)	$0 copay (limits may apply)
Oral exam (Out-of-Net)	$0 copay (limits may apply)
Oral exam (In-Network)	$0 copay (limits may apply)
Fluoride treatment (Out-of-Net)	$0 copay (limits may apply)
Dental x-ray(s) (In-Network)	$0 copay (limits may apply)
Dental x-ray(s) (Out-of-Net)	$0 copay (limits may apply)
Cleaning (Out-of-Net)	$0 copay (limits may apply)
Comprehensive Dental
Prosthodontics, other oral/maxillofacial surgery, other services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Periodontics (In-Network)	$0 copay (authorization required, limits may apply)
Non-routine 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)
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network)	$0 copay (authorization required, limits may apply)
Non-routine services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Extractions (In-Network)	$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)
Restorative services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Vision
Upgrades	Not covered
Routine eye exam (Out-of-Net)	30% coinsurance (authorization required, limits may apply)
Contact lenses (Out-of-Net)	$0 copay (limits may apply)
Eyeglasses (frames and lenses) (Out-of-Net)	$0 copay (limits may apply)
Routine eye exam (In-Network)	$0 copay (authorization required, limits may apply)
Contact lenses (In-Network)	$0 copay (limits may apply)
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Other	Not covered
Emergency Care / Urgent Care
Urgent care	$40 copay per visit (always covered)
Ground ambulance	20% coinsurance
Inpatient hospital coverage	$1,556 per stay
Outpatient hospital coverage	30% coinsurance per visit
Skilled Nursing Facility	$0 per day for days 1 through 100
Optional supplemental benefits	No

Prescription Costs & Benefits

A basic benefit Part D plan is bundled with this health plan. This simply means that UnitedHealthcare Nursing Home Plan 2 covers the minimum amount required by Medicare, whereas enhanced benefit plans cover more of the overall costs and may include more benefits.

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.

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 2 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.

CMS Rating Marks

The table below shows the quality ratings for this UnitedHealthcare plan. Each year Medicare rates Special Needs Plans using nine categories. We do not recommend joining a plan with an overall rating of less than 3 stars.

Do You Qualify to Join UnitedHealthcare Nursing Home Plan 2?

You will need to meet three requirements to be eligible to join UnitedHealthcare Nursing Home Plan 2:

1. You are eligible for Medicare;
2. You live in Kent County, Rhode Island; and
3. You need the level of care provided in an institutional environment, such as a long-term care nursing facility, for 90 days or more.

If you live at home and require skilled nursing care, you may qualify for an Institutional Equivalent Special Needs Plan (IE-SNP).

Medicare beneficiaries who don't qualify to enroll in UnitedHealthcare Nursing Home Plan 2, or another Special Needs Plan, are encouraged to look at Kent County Medicare Advantage plans options.

Contact UnitedHealthcare

The Medicare SNP Plans for Kent County, Rhode Island information on this page originates from Medicare.gov and was last updated by All Medicare on February 5, 2023.