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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 2026, 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 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-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 $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 $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) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are covered with no copay for standard pharmacy fills and standard mail orders. For all other drug tiers, including Tier 2 generic, Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, you will pay a 25% coinsurance. This 25% coinsurance applies to standard pharmacy and standard mail order options for both short-term and extended supplies.
Additional Benefits
The UHC Dual Complete NM-V1 (PPO D-SNP) plan offers comprehensive coverage with no copay or coinsurance for primary care, telehealth, and routine preventive services. For hospital care, inpatient stays require a $550 copay for the first few days and no copay for subsequent days, while emergency room visits carry a $130 copay that is waived if you are admitted. Specialist visits range from no copay to a $35 copay, while routine transportation and home health services are available with no copay. Ancillary benefits include routine dental, vision, and hearing exams with no copay, alongside a $200 eyewear allowance and covered over-the-counter items. Patients requiring medical equipment, dialysis, or Medicare Part B drugs will generally face a 20% coinsurance, while prescription hearing aid copays range from $199 to $1,249. Skilled nursing facility care is also covered with no copay for the first 20 days, followed by a $218 daily copay.
Inpatient Hospital See details
UHC Dual Complete NM-V1 (PPO D-SNP) covers inpatient hospital services with no coinsurance, featuring a $550 copay for days 1-5 of acute stays and days 1-4 of psychiatric stays, with no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
UHC Dual Complete NM-V1 (PPO D-SNP) covers outpatient services with no coinsurance, offering outpatient hospital services with a copay of $0 to $550 and observation services at $550 per day. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services feature no coinsurance and copays between $0 and $25.
Partial Hospitalization See details
Partial hospitalization is covered by UHC Dual Complete NM-V1 (PPO D-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
UHC Dual Complete NM-V1 (PPO D-SNP) covers ground and air ambulance services with a $275 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance, providing up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
UHC Dual Complete NM-V1 (PPO D-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature a copay of $0 to $50 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-V1 (PPO D-SNP) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialist visits range from a $0 to $35 copay with no coinsurance. Physical, occupational, speech, and podiatry therapies require a $35 copay and no coinsurance, whereas mental health services have copays up to $25 with no coinsurance, and chiropractic services are not covered in practice.
Preventive Services See details
UHC Dual Complete NM-V1 (PPO D-SNP) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. While additional benefits like fitness programs and home safety devices are covered with no copay and no coinsurance, other services such as health education, medical nutrition therapy, and personal emergency response systems are not covered.
Hearing Services See details
UHC Dual Complete NM-V1 (PPO D-SNP) provides partially covered hearing services, including one annual routine hearing exam with no copay and no coinsurance, while fitting and evaluation exams are not covered. The plan covers up to two prescription hearing aids (copays from $199 to $1,249) and two OTC hearing aids (copays from $199 to $829) per year with no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by UHC Dual Complete NM-V1 (PPO D-SNP), offering one routine eye exam per year with no copay and no coinsurance, and a $200 combined eyewear allowance every two years. Covered eyewear has no coinsurance and no copay, except for eyeglass lenses which have a copay of $0 to $153, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by UHC Dual Complete NM-V1 (PPO D-SNP), featuring Medicare-covered dental care with no copay and 20% coinsurance, alongside select preventive care with no copay and no coinsurance. Orthodontics, restorative services, endodontics, periodontics, prosthodontics, oral surgery, and other diagnostic dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Dual Complete NM-V1 (PPO D-SNP) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and require no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the UHC Dual Complete NM-V1 (PPO D-SNP) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
UHC Dual Complete NM-V1 (PPO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copays and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
UHC Dual Complete NM-V1 (PPO D-SNP) covers diagnostic and radiological services with prior authorization, offering lab services and diagnostic radiology with no copay and no coinsurance. Diagnostic tests and procedures require a $50 copay with no coinsurance, outpatient X-rays have a $25 copay with coinsurance, and therapeutic radiology incurs a 20% coinsurance plus a copay.
Home Health Services See details
UHC Dual Complete NM-V1 (PPO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
UHC Dual Complete NM-V1 (PPO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, 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-V1 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, though a prior three-day hospital stay is not, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
UHC Dual Complete NM-V1 (PPO D-SNP) partially covers other services, offering over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance, though meal benefits require prior authorization. Acupuncture, highly integrated services, and other additional services are not covered.
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