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UHC Dual Complete NM-Y1 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete NM-Y1 (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 NM-Y1 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete NM-Y1 (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 New Mexico. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that UHC Dual Complete NM-Y1 (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 NM-Y1 (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 NM-Y1 (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 NM-Y1 (PPO D-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 $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:
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Drug Coverage
The UHC Dual Complete NM-Y1 (PPO D-SNP) plan has an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at a standard pharmacy, or for a 3-month supply through standard mail order. This ensures that essential medications remain highly accessible and affordable. For Tier 2 generic, Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan charges a consistent 25% coinsurance. This 25% coinsurance rate applies to standard pharmacy fills as well as standard mail order services for eligible supply lengths. These clear cost-sharing details help you easily budget for your monthly and specialty medication needs.
Additional Benefits
The UHC Dual Complete NM-Y1 (PPO D-SNP) offers comprehensive healthcare coverage with many services featuring no copay. For inpatient hospital stays, members pay a $1,640 copay per admission with no coinsurance, while outpatient hospital services, primary care, and specialist visits require no copay and a coinsurance ranging from 0% to 20%. Emergency services carry a $115 copay, which is waived upon admission, while urgently needed care ranges from no copay to a $40 copay. This plan also features strong supplemental benefits, including no copay and no coinsurance for routine vision exams with a $200 eyewear allowance, and up to $3,000 in covered dental services. Hearing aids are covered with no copay and no coinsurance up to $2,200 every two years, and skilled nursing facility care is provided with no copay and no coinsurance. Additionally, members benefit from 24 one-way transportation trips per year, home health services, and select over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by UHC Dual Complete NM-Y1 (PPO D-SNP) with a $1,640 copay per admission and no coinsurance, requiring prior authorization. Unlimited additional acute care days are covered with no copay, but non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient Services are covered under UHC Dual Complete NM-Y1 (PPO D-SNP) with no copays, though coinsurance and prior authorization are required for many benefits. Covered services, including outpatient hospital, ambulatory surgical center, and outpatient substance abuse services, carry a 0% to 20% coinsurance, while outpatient blood services have a 20% coinsurance with no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the UHC Dual Complete NM-Y1 (PPO D-SNP) plan with a $55.00 copay and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
UHC Dual Complete NM-Y1 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
UHC Dual Complete NM-Y1 (PPO D-SNP) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require 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 NM-Y1 (PPO D-SNP) covers primary care and specialist visits with no copay and 0% to 20% coinsurance, while telehealth and opioid treatment feature no copay and no coinsurance. Physical, occupational, speech, and podiatry therapies require a 20% coinsurance and no copay, but chiropractic services are not covered as routine and other chiropractic services are excluded.
Preventive Services See details
Preventive services are covered by UHC Dual Complete NM-Y1 (PPO D-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, fitness benefits, weight management, in-home support, caregiver training, and home safety devices. This benefit is partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, smoking cessation, disease management, telemonitoring, remote access, and counseling are not covered. Glaucoma screenings and diabetes training have no copay, while digital rectal exams and post-welcome-visit EKGs require a 20% coinsurance.
Hearing Services See details
Hearing Services are partially covered by UHC Dual Complete NM-Y1 (PPO D-SNP) with no deductible. Routine hearing exams are covered once annually with no copay and 20% coinsurance, but fitting and evaluation exams are not covered. Prescription hearing aids (up to $2,200 every two years) and OTC hearing aids are covered with no copay and no coinsurance, though inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
UHC Dual Complete NM-Y1 (PPO D-SNP) offers partially covered vision services with no copay and no coinsurance, which include one routine eye exam per year and a $200 annual allowance for contact lenses, eyeglass lenses, and frames. Other eye exam services, upgrades, and packaged eyeglasses (lenses and frames) are not covered by the plan.
Dental Services See details
Dental services are partially covered by UHC Dual Complete NM-Y1 (PPO D-SNP), offering no copay and no coinsurance for most preventive and comprehensive services up to a $3,000 annual limit. Medicare-covered dental services require a 20% coinsurance and no copay, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
UHC Dual Complete NM-Y1 (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B drugs, including chemotherapy and other drugs, have a 0% to 20% coinsurance, while Part B insulin carries a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by UHC Dual Complete NM-Y1 (PPO D-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by UHC Dual Complete NM-Y1 (PPO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
UHC Dual Complete NM-Y1 (PPO D-SNP) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and diagnostic radiological services with no copay or coinsurance. Other diagnostic procedures, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance, with diagnostic procedures also requiring a copay and radiological services requiring no copay.
Home Health Services See details
UHC Dual Complete NM-Y1 (PPO D-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 Dual Complete NM-Y1 (PPO D-SNP) with no copay and require prior authorization, though some services are not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for peripheral artery disease rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by UHC Dual Complete NM-Y1 (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit does not require 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 NM-Y1 (PPO D-SNP) covers select other services, offering over-the-counter (OTC) items and meal benefits for chronic illnesses 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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