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UHC Dual Complete VA-Y4 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete VA-Y4 (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 VA-Y4 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete VA-Y4 (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 Virginia. The overall rating for this plan is not yet available for 2026.
It's important to know that UHC Dual Complete VA-Y4 (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 VA-Y4 (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 VA-Y4 (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 VA-Y4 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.90. You must continue to pay paying your reduced 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 VA-Y4 (PPO D-SNP) prescription drug coverage features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for both 1-month and 3-month supplies at standard pharmacies, as well as for 3-month supplies through standard mail order. For all other drug tiers, which include Tier 2 generics, Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, there is a consistent 25% coinsurance. This 25% coinsurance applies to filled prescriptions at standard pharmacies and through standard mail order.
Additional Benefits
The UHC Dual Complete VA-Y4 (PPO D-SNP) offers comprehensive healthcare coverage with no copay for primary care visits, outpatient services, and home health care, though some of these services may require up to 20% coinsurance. Inpatient hospital stays require a $1,980 copay per stay with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Diagnostic radiology, skilled nursing facility care, and worldwide emergency services are also fully covered with no copay and no coinsurance. This plan also provides robust supplemental benefits, including preventive and comprehensive dental care with no copay and no coinsurance up to a $2,500 annual limit. Vision and hearing benefits also feature no copays, providing a $300 annual allowance for eyewear and up to $2,200 every two years for hearing aids. Additionally, members can access up to 24 free one-way transportation trips per year and receive over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
UHC Dual Complete VA-Y4 (PPO D-SNP) offers partially covered inpatient hospital services with a $1,980 copay per stay and no coinsurance for Medicare-covered acute and psychiatric stays, both requiring prior authorization. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
UHC Dual Complete VA-Y4 (PPO D-SNP) covers outpatient services with no copay and no deductible, though prior authorization is required and coinsurance ranges from 0% to 20%. This includes outpatient hospital, ambulatory surgical center, substance abuse, and blood services, all of which feature no copay and up to 20% coinsurance.
Partial Hospitalization See details
UHC Dual Complete VA-Y4 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
UHC Dual Complete VA-Y4 (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 via taxi or medical transport with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
UHC Dual Complete VA-Y4 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a copay ranging from $0 to $40 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Primary Care benefits under UHC Dual Complete VA-Y4 (PPO D-SNP) offer covered services with no copay and coinsurance ranging from no coinsurance up to 20% for primary care, specialist, therapy, and mental health services. While additional telehealth and opioid treatment services feature no copay and no coinsurance, chiropractic services are not covered.
Preventive Services See details
UHC Dual Complete VA-Y4 (PPO D-SNP) offers partially covered preventive services, including annual physical exams, fitness benefits, weight management, and in-home support with no copays and no coinsurance. While digital rectal exams and post-welcome-visit EKGs require a 20% coinsurance, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete VA-Y4 (PPO D-SNP) with no deductible, offering one routine hearing exam annually with no copay and 20% coinsurance, and up to two OTC or prescription hearing aids every two years with no copay or coinsurance up to a $2,200 limit. However, fitting and evaluation exams, alongside 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 VA-Y4 (PPO D-SNP) with no copay and no coinsurance, providing one routine eye exam and a $300 annual limit for contacts, eyeglass lenses, and frames. Other eye exam services, combined eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
UHC Dual Complete VA-Y4 (PPO D-SNP) covers Medicare dental services with no copay and a 20% coinsurance, while other preventive and comprehensive dental benefits are covered with no copay and no coinsurance up to a $2,500 annual limit. This dental coverage is partial, as implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Dual Complete VA-Y4 (PPO D-SNP) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the UHC Dual Complete VA-Y4 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
UHC Dual Complete VA-Y4 (PPO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
UHC Dual Complete VA-Y4 (PPO D-SNP) covers diagnostic and radiological services, requiring prior authorization for all care. Diagnostic procedures and tests require a copay and 20% coinsurance, while lab services have no copay but are subject to coinsurance. Radiological services have no copays, with no coinsurance for diagnostic radiology and 20% coinsurance for therapeutic and outpatient X-ray services.
Home Health Services See details
Home health services are covered by UHC Dual Complete VA-Y4 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by UHC Dual Complete VA-Y4 (PPO D-SNP) with no copay, though prior authorization is required. While some services are covered, specific programs such as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by UHC Dual Complete VA-Y4 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required. While the plan does not require a prior three-day inpatient hospital stay for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by UHC Dual Complete VA-Y4 (PPO D-SNP), providing over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, though prior authorization is required for meals. Acupuncture is not covered under this benefit.
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