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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 2026, 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 3.5 out of 5 stars in 2026.
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 $600.00 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 $10100.00 (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 $10100.00 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) prescription drug plan has an annual drug deductible of $600. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies or through mail order. Tier 2 generic drugs are available with a $10 copay for a 1-month supply at standard pharmacies, though you can save with no copay for a 3-month supply when using preferred mail order. For brand-name and specialty medications, costs are structured as coinsurance. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs have a 40% coinsurance for a 1-month supply. Tier 5 specialty drugs require a 26% coinsurance for a 1-month supply at standard pharmacies and through mail order.
Additional Benefits
The UHC Complete Care WI-1 (PPO C-SNP) offers comprehensive coverage for essential medical needs, featuring no copay and no coinsurance for primary care doctor visits, preventive services, and home health care. Specialist visits, outpatient hospital services, and emergency room care require low to moderate copays and no coinsurance. For inpatient hospital stays, members pay a daily copay for the first several days, with no copay required for subsequent days. Routine dental cleanings, annual vision exams, and hearing tests are covered with no copay, while prescription hearing aids and eyewear are available with reasonable copays or allowance limits. Durable medical equipment and dialysis services require a 20% coinsurance, and skilled nursing facility stays are covered with no copay for the first 20 days.
Inpatient Hospital See details
UHC Complete Care WI-1 (PPO C-SNP) covers inpatient acute hospital stays with no coinsurance, requiring a $550 copay for days 1-5 and no copay for day 6 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance, featuring a $550 copay for days 1-4 and no copay for days 5-90, while additional days and non-Medicare-covered stays are excluded.
Outpatient Services See details
UHC Complete Care WI-1 (PPO C-SNP) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $550 and observation services with a $550 daily copay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a copay of $0 to $25 per session with no coinsurance.
Partial Hospitalization See details
UHC Complete Care WI-1 (PPO C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance services under UHC Complete Care WI-1 (PPO C-SNP) are covered with a $290 copay and no coinsurance for ground and air transport, with prior authorization required. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
UHC Complete Care WI-1 (PPO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a copay of $0 to $50 and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
UHC Complete Care WI-1 (PPO C-SNP) covers primary care physician services, telehealth, and routine podiatry with no copay and no coinsurance. Specialist visits require a $0 to $55 copay, physical and occupational therapies require a $50 to $55 copay, and mental health services range from a $0 to $25 copay, all with no coinsurance, while chiropractic services are not covered.
Preventive Services See details
UHC Complete Care WI-1 (PPO C-SNP) provides partially covered preventive services with no copay and no coinsurance for covered options like annual physicals, fitness benefits, and kidney education. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and counseling.
Hearing Services See details
UHC Complete Care WI-1 (PPO C-SNP) offers partially covered hearing services, including one routine annual exam with no copay and no coinsurance, though fitting and evaluation exams are not covered. Up to two prescription or OTC hearing aids are covered annually with no coinsurance, with copays ranging from $199 to $1,249 for prescription models and $199 to $829 for OTC models, though inner ear, outer ear, and over-the-ear prescription aids are excluded.
Vision Services See details
Vision services under UHC Complete Care WI-1 (PPO C-SNP) are partially covered, featuring no coinsurance and no copay for annual routine eye exams, contact lenses, and frames, while eyeglass lenses have a copay of $0.00 to $153.00 with no coinsurance. A combined $200 maximum benefit applies to eyewear every two years, but upgrades, other eye exams, and packaged eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by UHC Complete Care WI-1 (PPO C-SNP), offering preventive care like exams, cleanings, and X-rays with no copay and no coinsurance, while Medicare-covered dental services require a 20% coinsurance and no copay. Major services, including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics, are not covered.
Home Infusion bundled Services See details
UHC Complete Care WI-1 (PPO C-SNP) covers Home Infusion bundled Services with no copay, although prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Complete Care WI-1 (PPO C-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
UHC Complete Care WI-1 (PPO C-SNP) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment and supplies are covered with no copay and no coinsurance, though prior authorization is required and manufacturer limitations apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Complete Care WI-1 (PPO C-SNP) with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $60 copay for diagnostic tests, while radiological services require no copay for diagnostic radiology, a 20% coinsurance for therapeutic radiology, and a $25 copay plus coinsurance for outpatient X-rays.
Home Health Services See details
UHC Complete Care WI-1 (PPO C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by UHC Complete Care WI-1 (PPO C-SNP) with no copay and no coinsurance, though prior authorization is required. Only some services are covered in practice, as standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
UHC Complete Care WI-1 (PPO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior 3-day inpatient hospital stay is not required, additional days beyond the standard 100 days are not covered.
Other Services See details
UHC Complete Care WI-1 (PPO C-SNP) partially covers other services, providing over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required for the meal benefit.
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