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UHC Dual Complete NM-V1 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete NM-V1 (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-V1 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete NM-V1 (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-V1 (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-V1 (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-V1 (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-V1 (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 $10100.00 (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 $10100.00 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-V1 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After meeting your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase, and you will pay nothing for your Medicare Part D covered drugs. If you qualify for the low-income subsidy, you may have a reduced premium of $15.80.
Additional Benefits
The UHC Dual Complete NM-V1 (PPO D-SNP) plan offers a wide range of benefits with varying cost-sharing structures. Inpatient hospital stays have a copay, while outpatient services, including some mental health and substance abuse services, have copays. Emergency and preventive services generally have no copay, and transportation services are included. The plan also includes coverage for hearing, vision, and dental services, with copays or coinsurance depending on the specific service. Home health, medical equipment, and diagnostic services are covered with either a copay or coinsurance. Additionally, the plan covers home infusion, dialysis, and skilled nursing facility services, all with prior authorization requirements and varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the UHC Dual Complete NM-V1 (PPO D-SNP) plan, but require prior authorization. For acute care, you will pay a $375 copay for days 1-7, and no copay for days 8-90, while additional days 91-999 have no copay. For psychiatric care, you will pay a $375 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays and upgrades for acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $375, Observation Services with a $375 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, and Outpatient Blood Services with no copay. All services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete NM-V1 (PPO D-SNP) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including Ground and Air Ambulance Services, are covered. Ground and Air Ambulance Services have a $275 copay, while Transportation Services to a plan-approved health-related location has no copay and covers up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0 and $55. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, have no copay.
Primary Care See details
Under the UHC Dual Complete NM-V1 (PPO D-SNP) plan, primary care physician services have no copay, chiropractic services have a $20 copay, and occupational therapy services have a copay between $0 and $30. Physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, and physical therapy and speech-language pathology services have copays that vary between $0 and $30, while additional telehealth benefits and opioid treatment program services have no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, annual physical exams with no copay, and other preventive services including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Additional services such as 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. Fitness Benefit and Home and Bathroom Safety Devices and Modifications are covered with no copay, and Kidney Disease Education Services are covered with no copay.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are covered once per year with no copay, however fitting/evaluation for hearing aids is not covered. Prescription hearing aids are covered with a copay of $199-$1249, and OTC hearing aids are covered with a copay of $99-$829.
Vision Services See details
The UHC Dual Complete NM-V1 (PPO D-SNP) plan covers vision services, including eye exams with no copay, and eyewear with a combined maximum of $200 every two years. Contact lenses, eyeglass lenses, and eyeglass frames are covered with no copay, while 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. Other Dental Services include 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 with a $0 copay for many services, and coinsurance of 0-50% for prosthodontics, fixed. Implant services and orthodontics are not covered.
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%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the UHC Dual Complete NM-V1 (PPO D-SNP) plan. Prior authorization is required, and the coinsurance is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance; Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered, including diagnostic procedures and tests with a $50 copay, and lab services with no copay. Diagnostic radiological services have a maximum copay of $250, while therapeutic radiological services have a minimum coinsurance of 20%, and outpatient X-ray services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete NM-V1 (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 not covered by the UHC Dual Complete NM-V1 (PPO D-SNP) plan. Prior authorization is required for these services, but they are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the UHC Dual Complete NM-V1 (PPO D-SNP) plan with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $203.
Other Services See details
Under "Other Services," acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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. Over-the-counter (OTC) items and meal benefits are covered with no copay.
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