A non-government entity
UHC Dual Complete WI-D001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete WI-D001 (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Dual Complete WI-D001 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete WI-D001 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that UHC Dual Complete WI-D001 (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
UHC Dual Complete WI-D001 (PPO D-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 Dual Complete WI-D001 (PPO D-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 Dual Complete WI-D001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $9.00. 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 $615.00 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 $13900.00 (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 $13900.00 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:
Sign up for UHC Dual Complete WI-D001 (PPO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The UHC Dual Complete WI-D001 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and standard mail order. This plan provides an affordable option for those relying on common generic medications. For higher tier drugs, including Tier 2 generics, Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, members pay a 25% coinsurance. This 25% coinsurance applies to standard pharmacy and standard mail order options, covering up to a 3-month supply for Tiers 2 and 3, and a 1-month supply for Tiers 4 and 5. These cost-sharing details help beneficiaries plan for their out-of-pocket medication expenses with this Medicare Advantage plan.
Additional Benefits
The UHC Dual Complete WI-D001 (PPO D-SNP) offers comprehensive healthcare coverage with many essential medical services requiring no copays. For major medical needs, inpatient hospital stays require a $1,830 copay per stay with no coinsurance, while primary care, specialist visits, and outpatient services feature no copays and coinsurance ranging from 0% to 20%. Emergency care is covered with a $115 copay, which is waived upon admission, while urgent care and worldwide emergency services carry little to no copays. This plan also includes valuable supplemental benefits, such as dental care with no copay or coinsurance up to a $2,000 yearly limit and vision services featuring no copays, no coinsurance, and a $200 annual eyewear allowance. Members also benefit from hearing aid coverage, home health care, and skilled nursing facility stays with no copay and no coinsurance. Other services like durable medical equipment and dialysis require a 20% coinsurance with no copay, helping keep out-of-pocket costs predictable.
Inpatient Hospital See details
UHC Dual Complete WI-D001 (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,830 copay per stay and no coinsurance, with prior authorization required. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute care days are offered with no copay.
Outpatient Services See details
UHC Dual Complete WI-D001 (PPO D-SNP) covers outpatient services with no copayments, although prior authorization is required for most treatments. Covered services, including outpatient hospital, ambulatory surgical center, and outpatient substance abuse services, feature coinsurance ranging from no coinsurance to 20%, while outpatient blood services have a 20% coinsurance and no deductible.
Partial Hospitalization See details
UHC Dual Complete WI-D001 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by UHC Dual Complete WI-D001 (PPO D-SNP) with a 20% coinsurance and no copay for both ground and air transportation, subject to prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
UHC Dual Complete WI-D001 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature a copay ranging from $0 to $40 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
UHC Dual Complete WI-D001 (PPO D-SNP) covers primary care, specialist, telehealth, and mental health services with no copays and coinsurance ranging from 0% to 20%, while telehealth and opioid treatment have no coinsurance. Physical, occupational, and speech therapy require no copay and 20% coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
UHC Dual Complete WI-D001 (PPO D-SNP) partially covers preventive services, offering key benefits like annual physicals, fitness programs, and caregiver support with no copay and no coinsurance, while digital rectal exams and EKGs require a 20% coinsurance. Non-covered services include health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, smoking cessation counseling, disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
UHC Dual Complete WI-D001 (PPO D-SNP) offers partially covered hearing services, including routine hearing exams with a 20% coinsurance and no copay, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are covered up to $2,200 every two years with no copay and no coinsurance, but fitting and evaluation exams, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by UHC Dual Complete WI-D001 (PPO D-SNP) with no copays, no coinsurance, and no deductibles. The plan covers one routine eye exam per year and provides a $200 annual allowance for contact lenses, eyeglass lenses, and frames, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
UHC Dual Complete WI-D001 (PPO D-SNP) partially covers dental services with no copay and no coinsurance for preventive and most comprehensive services up to a $2,000 yearly limit, while Medicare-covered dental services have no copay and a 20% coinsurance. Implant services and orthodontics are not covered by this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by UHC Dual Complete WI-D001 (PPO D-SNP) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance with no copay, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
UHC Dual Complete WI-D001 (PPO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment benefits under UHC Dual Complete WI-D001 (PPO D-SNP) are covered with no copays, though a 20% coinsurance applies to durable medical equipment (DME), prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies from specified manufacturers are covered with no copay, and prior authorization is required for most of these medical equipment services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under UHC Dual Complete WI-D001 (PPO D-SNP) with prior authorization, offering diagnostic radiological services with no copay and no coinsurance, and lab services with no copay. Diagnostic procedures and tests require a copay and a minimum 20% coinsurance, while therapeutic radiological and outpatient X-ray services have no copay and a minimum 20% coinsurance.
Home Health Services See details
UHC Dual Complete WI-D001 (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
UHC Dual Complete WI-D001 (PPO D-SNP) covers cardiac rehabilitation services with no copay, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice and require 20% coinsurance.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete WI-D001 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UHC Dual Complete WI-D001 (PPO D-SNP) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered, and prior authorization is required for the meal benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved