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UHC Complete Care WI-1 (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Complete Care WI-1 (PPO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Complete Care WI-1 (PPO C-SNP) in 2025, please refer to our full plan details page.
UHC Complete Care WI-1 (PPO C-SNP) is a PPO C-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Wisconsin. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that UHC Complete Care WI-1 (PPO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
UHC Complete Care WI-1 (PPO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about UHC Complete Care WI-1 (PPO C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For UHC Complete Care WI-1 (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $340.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6700.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $6700.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The UHC Complete Care WI-1 (PPO C-SNP) plan has a $340 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $10 copay for preferred generic drugs at a standard pharmacy, and a $47 copay for standard generic drugs. For preferred brand drugs, you will pay a $100 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The UHC Complete Care WI-1 (PPO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $415 copay for days 1-5, and no copay for days 6-90. Outpatient services have copays that vary from $0 to $415, while emergency services have a $125 copay. This plan also includes no copay for primary care visits, hearing exams, eye exams, and preventive services. It covers dental services with 20% coinsurance, and offers no copay for home health services. Additional benefits include coverage for hearing aids, vision, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-5, there is a $415 copay, while days 6-90 have no copay; additional days for Inpatient Hospital-Acute have no copay.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $415, observation services with a $415 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $0 and $5 for individual sessions, no copay for group sessions, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Complete Care WI-1 (PPO C-SNP) plan with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Complete Care WI-1 (PPO C-SNP) plan. Ground and air ambulance services both have a $290 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, Urgently Needed Services have a copay between $0-$55, and Worldwide Emergency Services have a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The UHC Complete Care WI-1 (PPO C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a copay between $0 and $25. Physician specialist services have a copay between $0 and $35, while mental health specialty services have a copay between $0 and $5 for individual sessions, and no copay for group sessions. Podiatry services and routine foot care have no copay, and other health care professionals and psychiatric services have a copay between $0 and $35 and $0 and $5 respectively. Physical therapy and speech-language pathology services have a copay between $0 and $25, additional telehealth benefits have no copay, and opioid treatment program services have no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero-dollar preventive services, annual physical exams with no copay, and additional preventive services, with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay, with a limit of one exam per year, while fitting/evaluation for hearing aids is not covered. Prescription hearing aids have a copay between $199 and $1249, and OTC hearing aids have a copay between $99 and $829.
Vision Services See details
Vision services include coverage for eye exams with no copay, and eyewear benefits. Eyewear includes coverage for contact lenses, eyeglass lenses, and eyeglass frames with no copay, though eyeglass frames are limited to one every two years. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Complete Care WI-1 (PPO C-SNP) plan covers Medicare Dental Services with 20% coinsurance and other dental services with no details provided. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay. However, orthodontic services, restorative services, and other services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the UHC Complete Care WI-1 (PPO C-SNP) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Complete Care WI-1 (PPO C-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, as well as Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, but with a copay for some services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a $45 copay, Lab Services with no copay, Diagnostic Radiological Services with a copay of at most $250, Therapeutic Radiological Services with a coinsurance of at most 20%, and Outpatient X-Ray Services with a $25 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the UHC Complete Care WI-1 (PPO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Complete Care WI-1 (PPO C-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
The UHC Complete Care WI-1 (PPO C-SNP) plan's "Other Services" benefit includes over-the-counter items and meal benefits. Over-the-counter items have no copay, and meal benefits also have no copay, but require prior authorization. Acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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