Medicare Plans

Open Medicare Plan Data.

UHC Care Advantage WI-E001 (HMO-POS I-SNP) H5253-064 • 2027 • Dane County, WI

CMS Rating: Not yet rated by CMS.
Monthly Premium
$6.30Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$4000.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $270.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Dane County, WI
Local Enrollment
19 beneficiaries in Dane County
Last update:

Introduction

CMS Plan ID H5253-064 identifies UHC Care Advantage WI-E001, a Medicare Advantage Institutional Special Needs Plan (I-SNP) offered by UnitedHealthcare. Its provider network is a Health Maintenance Organization with a Point of Service (HMO-POS), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $6.30 monthly premium, $0.00 medical deductible, and $4000.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $270.00.

Enrollment in this plan requires you to live in Dane County, Wisconsin. CMS reports 19 beneficiaries enrolled in this plan in Dane County. New members can call the plan directly at (888)834-3721 (TTY 711) for assistance.

Eligibility

UHC Care Advantage WI-E001 is a Institutional-equivalent (IE-SNP) plan designed for individuals who need nursing-level care.

Special Needs Plan Type
Institutional Special Needs Plan (I-SNP)
Medicare Requirement
Must have Medicare Part A and Part B
Special Needs Requirement
This is an Institutional-Equivalent plan for individuals who need the level of care given in a facility who can remain at home, live in a group home setting, or an assisted living facility.
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Compare Similar Plans in Dane County

Compare this plan with the most-enrolled other HMO-POS I-SNP plan available in Dane County, Wisconsin. Enrollment is based on CMS local enrollment data.

HMO-POS I-SNP plan comparison for Dane County, Wisconsin
Plan Detail UHC Care Advantage WI-E001 UHC Nursing Home Plan WI-F001
CMS Plan ID H5253-064-0 H5253-007-0
Local Enrollment 19 0
Monthly Premium $6.30 $0.00
Medical Deductible Coming soon Coming soon
Maximum Out-of-Pocket $4,000.00 $9,850.00
Part B Giveback Coming soon Coming soon
Primary Care Coming soon Coming soon
Specialist Coming soon Coming soon
Part D Deductible $270.00 $700.00
CMS Star Rating Not yet rated Not yet rated
Dental Coming soon Coming soon
Vision Coming soon Coming soon
Hearing Coming soon Coming soon

Plan Benefits

UHC Care Advantage WI-E001 has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5253-064.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5253-064-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Out-of-network: 30% coinsurance
Specialist
In-network: $0-$35 copay
Out-of-network: 30% coinsurance

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Out-of-network: 30% coinsurance
Telehealth benefit
Not covered
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
Not covered
Over-the-counter drug benefits
In-network: $0 copay
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Outpatient x-rays
In-network: $30 copay
Out-of-network: 30% coinsurance
Diagnostic tests and procedures
In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Emergency and Urgent Care Services

Emergency room care
$150 copay
Worldwide emergency care
Coming soon
Urgent care
$0-$65 copay
Inpatient hospital care
In-network:
Tier 1
$350 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
30% per stay
Skilled Nursing Facility
In-network:
Tier 1
$0 per day for days 1-100
Out-of-network:
30% per stay
Ground ambulance
In-network: $275 copay
Out-of-network: $275 copay

Mental Health Services

Outpatient individual therapy
In-network: $0-$25 copay
Out-of-network: 30% coinsurance
Outpatient group therapy
In-network: $15 copay
Out-of-network: 30% coinsurance
Inpatient psychiatric hospital care
In-network:
Tier 1
$350 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
30% per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $35 copay
Out-of-network: 30% coinsurance
Occupational therapy
In-network: $35 copay
Out-of-network: 30% coinsurance

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Out-of-network: 30% coinsurance
Durable medical equipment
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Prosthetics
In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance

Medicare Part B Drugs

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

Dental Services

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Implant services
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay

Vision Services

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

Hearing Services

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

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
Not covered
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
Not covered
Massage therapy
Not covered
Home/bathroom safety devices
In-network: $0 copay

Certain preventive services are covered 100% by UHC Care Advantage WI-E001 as a Part B benefit.

Prescription Drug Coverage

UHC Care Advantage WI-E001 includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

UHC Care Advantage WI-E001 (H5253-064-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:$6.30
Supplemental Part D Premium:$0.00
Total Part D Premium:$6.30
Low-Income Premium Subsidy:$6.27
Low-Income Premium Subsidy Paid by CMS:$6.30
Low-Income Subsidy Premium:$0.00

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $270.00 annual Part D deductible. You'll pay this deductible at the pharmacy before UnitedHealthcare starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, UHC Care Advantage WI-E001 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

UHC Care Advantage WI-E001 (H5253-064-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copay$0.00 copay
Generic$8.00 copay$12.00 copay
Preferred Brand24% coinsurance25% coinsurance
Non-Preferred Drug35% coinsurance50% coinsurance
Specialty Tier30% coinsurance30% coinsurance
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H5253)

Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.

2027 Medicare Star Ratings for Contract H5253
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
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 ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Contact Information for UnitedHealthcare

Website
UnitedHealthcare Plan Page
Providers
UnitedHealthcare Providers Page
Formulary
UnitedHealthcare Formulary Page
Pharmacy
UnitedHealthcare Pharmacy Page
New Member Health Plan Help
(888)834-3721
New Member Health Plan TTY
711
New Member Part D Help
(888)834-3721
New Member Part D TTY Users
711

Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
UnitedHealthcare (official source) http://UHC.com/Medicare October 4, 2026
CMS.gov Institutional Special Needs Plans (I-SNPs) April 28, 2026
Medicare.gov Understanding Medicare Advantage Plans April 28, 2026
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You April 28, 2026

MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.

Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.