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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 2025, 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 Select Counties in New Mexico. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $15.80. 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 $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 NM-Y1 (PPO D-SNP) plan has a $590.00 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs depending on the tier and pharmacy type. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), also known as "Extra Help," and you will pay $15.80 per month. Once your total drug costs reach $2000.00, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The UHC Dual Complete NM-Y1 (PPO D-SNP) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient hospital services, with copays and coinsurance depending on the specific service. Additionally, the plan offers coverage for primary care, preventive services, hearing, vision, and dental services, often with no copay or low coinsurance. This plan also provides coverage for ambulance and transportation services, emergency services, and home health services. It also covers a range of other services, including home infusion, dialysis, medical equipment, and diagnostic services. This plan also includes coverage for OTC items and meal benefits, both with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with prior authorization required. For Inpatient Hospital-Acute, there is a copay of $1,275 per admission for a Medicare-covered stay, and additional days for Inpatient Hospital-Acute have no copay for days 91-999. Non-Medicare-covered stays and upgrades are not covered for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays are not covered for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the UHC Dual Complete NM-Y1 (PPO D-SNP) plan with coinsurance costs ranging from 0% to 20%, depending on the specific service. Observation services have a 20% coinsurance, while Ambulatory Surgical Center services have a coinsurance that ranges from 0% to 20%. Outpatient Substance Abuse Services, including individual sessions (0-20% coinsurance) and group sessions (20% coinsurance), are covered. Outpatient Blood Services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete NM-Y1 (PPO D-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 Dual Complete NM-Y1 (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered with no copay for up to 60 one-way trips per year via taxi or medical transport.
Emergency Services See details
Emergency Services are covered, with a $110 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $45, and no coinsurance. Worldwide Emergency Services are covered, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, all with no copay and no coinsurance.
Primary Care See details
Primary Care, including Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services, are covered. Chiropractic Services are covered, with a 20% coinsurance for Routine Care. Podiatry Services are covered with a 20% coinsurance for Routine Foot Care, while Medicare-covered Podiatry 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, kidney disease education services with no copay, and other preventive services. Other preventive services include glaucoma screening, diabetes self-management training, and barium enemas with no copay, as well as digital rectal exams and EKG following a welcome visit, both with 20% coinsurance. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with no copay and a coinsurance of at most 20%, and OTC hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $3200. Fitting/evaluation for hearing aids, and prescription hearing aids (inner ear, outer ear, and over the ear) are not covered.
Vision Services See details
The UHC Dual Complete NM-Y1 (PPO D-SNP) plan covers vision services, including eye exams, routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams and routine eye exams have no copay, and contact lenses, eyeglass lenses, and eyeglass frames also have no copay. Eyewear has a combined maximum of $400 per year, and eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no copay, but have varying limits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete NM-Y1 (PPO D-SNP) plan, but require prior authorization. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices, Medical Supplies, and Diabetic Equipment, all requiring prior authorization. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the UHC Dual Complete NM-Y1 (PPO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete NM-Y1 (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 by the UHC Dual Complete NM-Y1 (PPO D-SNP) plan, but not covered in practice, as the plan does not cover any of the sub-services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered for SNF, or non-Medicare-covered stays for SNF. Prior authorization is required, and you will pay the Medicare-defined cost share for tier 1, with the copay information available separately.
Other Services See details
The UHC Dual Complete NM-Y1 (PPO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits. OTC items have no copay, while meal benefits also have no copay and 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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