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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 2025, 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 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-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 $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-S1 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay costs for drugs in each tier until your total drug costs reach $2000, at which point you will enter the next coverage phase. If you qualify for the low-income subsidy, you may have a reduced premium. During the catastrophic coverage phase, after your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete NM-S1 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1275 copay per admission, while outpatient services, primary care, and diagnostic services typically have a coinsurance between 0% and 20%. Emergency services have a $110 copay, and there is no copay for preventive services, hearing exams, vision exams, and many dental services. The plan also includes coverage for ambulance services, home health, and medical equipment with coinsurance requirements. Additionally, it provides no copay for transportation services, OTC items, and meal benefits. Prescription hearing aids and eyewear are covered without a copay, and there is a $3,000 annual maximum for dental services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization and have a copay of $1275 per admission or stay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute have no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered under the UHC Dual Complete NM-S1 (PPO D-SNP) plan. Outpatient Hospital Services have a coinsurance of 0% - 20%, Observation Services have a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services have a coinsurance between 0% and 20%. Individual Sessions for Outpatient Substance Abuse have a coinsurance between 0% and 20%, and Group Sessions for Outpatient Substance Abuse have a 20% coinsurance. Outpatient Blood Services have a 20% coinsurance, and the plan waives the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete NM-S1 (PPO D-SNP) plan. This benefit has a $55 copay and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by UHC Dual Complete NM-S1 (PPO D-SNP), including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are also covered, with no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the UHC Dual Complete NM-S1 (PPO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay of $0 - $45; there is no coinsurance for either service. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The UHC Dual Complete NM-S1 (PPO D-SNP) plan covers primary care physician services with a coinsurance of 0% to 20%, chiropractic services with 20% coinsurance, and occupational therapy services with a coinsurance of 0% to 20%. The plan also covers physician specialist services, mental health specialty services, and psychiatric services with 0% to 20% coinsurance, and podiatry services, other health care professional, physical therapy, and speech-language pathology services with 0% to 20% coinsurance. Additional telehealth benefits are covered with no copay, and Opioid Treatment Program Services are covered with no copay.
Preventive Services See details
Preventive Services include Medicare-covered zero dollar services, annual physical exams with no copay, additional preventive services, kidney disease education services, and other preventive services. Additional preventive services, Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas have no copay, while Digital Rectal Exams and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay and a 20% coinsurance, while fitting/evaluation for hearing aids are not covered. Prescription hearing aids have no copay, up to $2,500 per year for both in-network and out-of-network services, and OTC hearing aids have no copay for up to 2 hearing aids per year.
Vision Services See details
Vision services include eye exams, and eyewear. Eye exams have no copay. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay, and a combined maximum benefit of $400 per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Dual Complete NM-S1 (PPO D-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic and preventive services, and prophylaxis with no copay. Medicare Dental Services have a 20% coinsurance. Restorative services, endodontics, periodontics, prosthodontics, and oral surgery are covered with no copay. However, implants and orthodontics are not covered. The plan offers a maximum benefit of $3,000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete NM-S1 (PPO D-SNP) plan, with a coinsurance between 20% and 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment is covered by UHC Dual Complete NM-S1 (PPO D-SNP), including Durable Medical Equipment with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Supplies with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the UHC Dual Complete NM-S1 (PPO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, and Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete NM-S1 (PPO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not the specific sub-services including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a coinsurance for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the plan charges the Medicare-defined cost share for tier 1, with no copay or coinsurance information provided.
Other Services See details
The UHC Dual Complete NM-S1 (PPO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits, with no copay for either. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered, and many other services are also not covered.
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