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UHC Dual Complete TX-D004 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete TX-D004 (HMO-POS 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 TX-D004 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete TX-D004 (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Texas. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that UHC Dual Complete TX-D004 (HMO-POS 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 TX-D004 (HMO-POS 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 TX-D004 (HMO-POS 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 TX-D004 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $1.40. 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 Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 TX-D004 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, 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, you will pay $1.40 for Part D.
Additional Benefits
The UHC Dual Complete TX-D004 (HMO-POS D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $2,000 copay, while outpatient services and many primary care services have coinsurance between 0% and 20%. Emergency and urgent care services have a copay, and some services like home health, hearing exams, and preventive services have no copay. Additional benefits include coverage for hearing aids up to $1500 per year, vision services with no copay for routine exams and eyewear, and dental services with no copay for preventive care and a $1,500 annual maximum. The plan also covers ambulance and transportation services with coinsurance, and offers coverage for medical equipment, diagnostic services, and home infusion with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but there is a $2,000 copay per admission or stay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute have no copay, but non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and the Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a coinsurance between 0% and 20%, Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a coinsurance between 0% and 20%, Outpatient Substance Abuse Services (Individual Sessions with a coinsurance between 0% and 20%, and Group Sessions with a 20% coinsurance), and Outpatient Blood Services with a 20% coinsurance. Prior authorization and a doctor referral are required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete TX-D004 (HMO-POS D-SNP) plan. There is a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the UHC Dual Complete TX-D004 (HMO-POS D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services to a plan-approved health-related location are covered with no copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UHC Dual Complete TX-D004 (HMO-POS D-SNP) plan. For Emergency Services, the copay is $110, and there is no coinsurance. Urgently Needed Services have a copay between $0 and $45, with no coinsurance, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
Primary Care benefits include Primary Care Physician Services with a coinsurance of 0% - 20%, Chiropractic Services with a 20% coinsurance, Occupational Therapy Services with a 0% - 20% coinsurance, Physician Specialist Services with a 0% - 20% coinsurance, Mental Health Specialty Services with a 0% - 20% coinsurance for Individual Sessions and 20% coinsurance for Group Sessions, Podiatry Services with a 20% coinsurance and no copay, Other Health Care Professional with a 0% - 20% coinsurance, Psychiatric Services with a 0% - 20% coinsurance for Individual Sessions and 20% coinsurance for Group Sessions, Physical Therapy and Speech-Language Pathology Services with a 0% - 20% coinsurance and no copay, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
The UHC Dual Complete TX-D004 (HMO-POS D-SNP) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services such as Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas with no copay, while the Digital Rectal Exams and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services include coverage for routine hearing exams with no copay, but a coinsurance of at most 20% is required, and prescription hearing aids with a maximum benefit of $1500 per year with no copay. Over-the-counter hearing aids are covered with no copay.
Vision Services See details
The UHC Dual Complete TX-D004 (HMO-POS D-SNP) plan covers vision services, including routine eye exams and eyewear. Routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames have no copay, while eyeglasses (lenses and frames) and upgrades are not covered. Eyewear has a combined maximum benefit of $200 every year.
Dental Services See details
The UHC Dual Complete TX-D004 (HMO-POS D-SNP) plan covers dental services, including oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Medicare Dental Services are covered with a 20% coinsurance, and other dental services have a $1,500 maximum benefit every year. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery are covered with no copay, but require prior authorization. However, Implant Services and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including 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 other drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete TX-D004 (HMO-POS D-SNP) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Therapeutic Radiological Services have a coinsurance of up to 20%, while Diagnostic Radiological Services have a coinsurance of up to 20% with a minimum of 0%. Lab Services have no copay, while Outpatient X-Ray Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete TX-D004 (HMO-POS 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 under the UHC Dual Complete TX-D004 (HMO-POS D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
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. Prior authorization and a doctor referral are required, and you will pay the Medicare-defined cost share for tier 1.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, while acupuncture, meal benefits, 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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