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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 2025, 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 2025.
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 $30.70. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.70. 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 $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 VA-Y4 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly Part D premium will be $30.70. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs, but you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The UHC Dual Complete VA-Y4 (PPO D-SNP) plan offers a variety of benefits with varying cost-sharing. Hospital stays have a $1565 copay per admission, while outpatient services and other services like ambulance, dialysis, and medical equipment have coinsurance costs. Emergency and preventive services, including an annual physical exam, have no copay. The plan also covers hearing, vision, and dental services. Hearing exams have no copay, and prescription hearing aids are covered with a $2200 maximum annual benefit. Vision services include eye exams and eyewear with no copay, and dental services have a 20% coinsurance for Medicare dental services, plus a $2500 annual maximum benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you will pay a copay of $1565.00 per admission or stay for a Medicare-covered stay, and additional days (91-999) have no copay. Non-Medicare-covered stays and upgrades are not covered, and for Inpatient Hospital Psychiatric, additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a 0% - 20% coinsurance, observation services with a 20% coinsurance, ambulatory surgical center services with a 0% - 20% coinsurance, outpatient substance abuse services with a 0% - 20% coinsurance for individual sessions and a 20% coinsurance for group sessions, and outpatient blood services with a 20% coinsurance. Prior authorization is required for all outpatient services.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete VA-Y4 (PPO D-SNP) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $110 copay, and no coinsurance, while Urgently Needed Services has a copay between $0 and $45, and no coinsurance. Worldwide Emergency Services has no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Under the UHC Dual Complete VA-Y4 (PPO D-SNP) plan, primary care physician services, occupational therapy, physician specialist services, mental health specialty services (individual and group sessions), psychiatric services (individual and group sessions), physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Chiropractic services are partially covered, with Routine Care not covered, and podiatry services are covered, with Routine Foot Care subject to 20% coinsurance.
Preventive Services See details
The UHC Dual Complete VA-Y4 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Other preventive services like glaucoma screenings, diabetes self-management training, and barium enemas have no copay, while digital rectal exams and EKG following a welcome visit have 20% coinsurance.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of at most 20% for routine hearing exams, and no copay. Prescription Hearing Aids are covered, with no copay and a maximum benefit of $2200 per year. OTC Hearing Aids are covered with no copay. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision Services includes eye exams and eyewear. Eye exams have no copay and include routine eye exams. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay, but eyeglass frames and lenses are limited to one per year, and there is a combined maximum of $300 per year for all eyewear. Eyeglass 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 have a maximum plan benefit of $2500 every year. 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 have no copay. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin, Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay with 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the UHC Dual Complete VA-Y4 (PPO D-SNP) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the UHC Dual Complete VA-Y4 (PPO D-SNP) plan, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies, and no copay. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the UHC Dual Complete VA-Y4 (PPO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete VA-Y4 (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 covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. The copay is determined by the Medicare-defined cost share for tier 1.
Other Services See details
Other Services offered by the UHC Dual Complete VA-Y4 (PPO D-SNP) plan include Over-the-Counter (OTC) Items and a Meal Benefit. Over-the-Counter (OTC) Items have no copay, and the Meal Benefit also has no copay, but requires prior authorization. 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.
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