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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 2025, 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 out of 5 stars in 2025.
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 $43.50. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.40. You must continue to pay paying your reduced 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 $590.00 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 $14000.00 (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 $14000.00 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 Dual Complete WI-D001 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy, your monthly premium for Part D is $43.50. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete WI-D001 (PPO D-SNP) plan offers comprehensive coverage with a focus on outpatient and preventive care. Many services have no copay, including primary care telehealth, hearing and vision exams, and ambulance services. Inpatient hospital stays have a copay of $1615 per admission, while outpatient services typically involve coinsurance between 0% and 20%. The plan also includes benefits like dental services, hearing aids, and medical equipment, with varying cost-sharing structures.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $1615 copay per admission or stay for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute has no copay, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a coinsurance of 0% to 20%, Observation Services have a 20% coinsurance, Ambulatory Surgical Center Services have a coinsurance between 0% and 20%, Individual Sessions for Outpatient Substance Abuse have a coinsurance between 0% and 20%, Group Sessions for Outpatient Substance Abuse have a 20% coinsurance, and Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the UHC Dual Complete WI-D001 (PPO D-SNP) plan, with no copay for all ambulance services, ground ambulance services and air ambulance services. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location are covered for 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the UHC Dual Complete WI-D001 (PPO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0-$45; there is no coinsurance for either service. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.
Primary Care See details
The UHC Dual Complete WI-D001 (PPO D-SNP) plan covers primary care physician services with a coinsurance of 0% to 20%, chiropractic services with a 20% coinsurance, occupational therapy services with a coinsurance of 0% to 20%, and additional telehealth benefits with no copay. The plan also covers physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, and opioid treatment program services. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay. Other preventive services include Fitness Benefit and Home and Bathroom Safety Devices and Modifications, which have no copay. Other services such as Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas have no copay. Digital Rectal Exams and EKG following Welcome Visit have a 20% coinsurance. 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 (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids, with some services requiring prior authorization. Routine hearing exams have no copay and a 20% coinsurance, and OTC hearing aids have no copay. Prescription hearing aids have a maximum plan benefit coverage of $2200 per year.
Vision Services See details
The UHC Dual Complete WI-D001 (PPO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay. The plan provides coverage for routine eye exams once per year, and for contact lenses, eyeglass lenses, and eyeglass frames, each once per year. Eyeglass frames have a combined maximum plan benefit coverage of $250 per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services are covered, with 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. However, implant services and orthodontics 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 with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete WI-D001 (PPO D-SNP) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, with Diabetic Supplies having no copay and Diabetic Therapeutic Shoes/Inserts having 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services have no copay.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete WI-D001 (PPO D-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice as the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and a Meal Benefit, with acupuncture and several other services not covered. Over-the-Counter (OTC) Items have no copay, while the Meal Benefit also has no copay and requires prior authorization.
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