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UHC Dual Complete NM-S1 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete NM-S1 (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-S1 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete NM-S1 (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-S1 (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-S1 (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-S1 (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-S1 (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-S1 (PPO D-SNP) prescription drug plan features an annual deductible of $615. Under this plan, you will benefit from no copay on Tier 1 preferred generic drugs for one-month and three-month supplies at standard pharmacies, as well as three-month standard mail orders. For all other drug tiers, you will transition to a coinsurance-based cost-sharing model. Tier 2 generic drugs, Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs all require a 25% coinsurance for standard pharmacy fills and standard mail orders.
Additional Benefits
The UHC Dual Complete NM-S1 (PPO D-SNP) offers comprehensive medical coverage with no copays for primary care visits, outpatient services, and home health care, though some services may require up to a 20% coinsurance. Inpatient hospital stays require a $1,545 copay per stay with no coinsurance, while emergency room visits feature a $115 copay that is waived if you are admitted within 24 hours. Additionally, skilled nursing facility stays are covered with no copay and no coinsurance, providing affordable recovery options. This plan also includes valuable everyday benefits, such as routine dental care up to a $3,000 annual limit and routine vision exams with a $200 eyewear allowance, both with no copays or coinsurance. Members can access routine hearing exams with no copay and 20% coinsurance, alongside coverage for up to two hearing aids every two years with no copay or coinsurance. Furthermore, the plan provides up to 24 one-way transportation trips per year to approved locations and covers select over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
UHC Dual Complete NM-S1 (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,545 copay per stay and no coinsurance, subject to prior authorization. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, although unlimited additional acute care days are covered with no copay.
Outpatient Services See details
UHC Dual Complete NM-S1 (PPO D-SNP) covers outpatient services with no copay, though prior authorization is required for most treatments. Outpatient hospital, ambulatory surgical center, and outpatient substance abuse services feature no copay and coinsurance ranging from no coinsurance to 20%, while outpatient blood services have no copay, 20% coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered under the UHC Dual Complete NM-S1 (PPO D-SNP) plan with a $55.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
UHC Dual Complete NM-S1 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any other health-related locations are not covered.
Emergency Services See details
Emergency Services for UHC Dual Complete NM-S1 (PPO D-SNP) are covered 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 and 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-S1 (PPO D-SNP) offers primary care benefits with no copays, though coinsurance ranges from no coinsurance up to 20% for primary care, specialists, mental health, and physical therapy. Chiropractic services are not covered, while telehealth and opioid treatment services are covered with no copays and no coinsurance.
Preventive Services See details
UHC Dual Complete NM-S1 (PPO D-SNP) provides partially covered preventive services, offering no copay and no coinsurance for annual physicals, glaucoma screenings, diabetes training, and fitness benefits. Digital rectal exams and post-welcome visit EKGs require a 20% coinsurance with no copay, while several sub-services like health education, medical nutrition therapy, and personal emergency response systems are not covered.
Hearing Services See details
UHC Dual Complete NM-S1 (PPO D-SNP) offers partial coverage for hearing services, providing one routine hearing exam per year with no copay and 20% coinsurance, while fitting and evaluation exams are not covered. Up to two prescription or OTC hearing aids are covered every two years with no copay or coinsurance (including a $2,200 maximum limit for prescription aids), though inner, outer, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by UHC Dual Complete NM-S1 (PPO D-SNP) with no copay and no coinsurance, offering one routine eye exam per year and a $200 annual limit for contact lenses, eyeglass lenses, and frames. This benefit is partially covered, as other eye exam services, upgrades, and combined eyeglasses (lenses and frames) packages are not covered.
Dental Services See details
Dental services are partially covered by UHC Dual Complete NM-S1 (PPO D-SNP), offering Medicare-covered dental services with no copay and a 20% coinsurance, and other preventive and comprehensive dental care with no copay and no coinsurance up to a $3,000 annual limit. Implant services and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
UHC Dual Complete NM-S1 (PPO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs carry no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by UHC Dual Complete NM-S1 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
UHC Dual Complete NM-S1 (PPO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are offered with no copay, and diabetic therapeutic shoes and inserts carry a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete NM-S1 (PPO D-SNP) with prior authorization. Diagnostic procedures require a copay and 20% coinsurance, lab services have no copay but require coinsurance, and radiological services feature no copays, with a 20% coinsurance for therapeutic and X-ray services and no coinsurance for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by UHC Dual Complete NM-S1 (PPO D-SNP) 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-S1 (PPO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete NM-S1 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. The benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, but admission is allowed without a prior three-day inpatient hospital stay.
Other Services See details
UHC Dual Complete NM-S1 (PPO D-SNP) partially covers other services, offering select Over-the-Counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and other additional services are not covered under this benefit, and prior authorization is required for the meal benefit.
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