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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 2026, 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 2026.
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 $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 $137.00 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 $9250.00 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 features an annual drug deductible of $137. For Tier 1 Preferred Generic and Tier 2 Generic drugs, you will pay no copay for your prescriptions at standard pharmacies and standard mail order. This no-copay benefit applies to both one-month and three-month supplies of these generic medications. For higher-tier drugs, including Tier 3 Preferred Brand, Tier 4 Non-Preferred, and Tier 5 Specialty Tier drugs, you will pay a 25% coinsurance. This 25% coinsurance rate applies to standard pharmacy fills and standard mail order options. Knowing these copay and coinsurance details helps you plan your healthcare budget with the UHC Dual Complete TX-D004 plan.
Additional Benefits
The UHC Dual Complete TX-D004 (HMO-POS D-SNP) offers comprehensive medical coverage with many services featuring no copayments. For inpatient hospital stays, beneficiaries pay no coinsurance but face a copay of $2,230 for acute care and $2,080 for psychiatric care per stay. Outpatient services, primary care, and specialist visits generally require no copay, though coinsurance ranges from 0% to 20% depending on the specific service. This plan also includes valuable supplemental benefits such as dental, vision, hearing, and transportation services with low out-of-pocket costs. Vision and routine dental care are available with no copay and no coinsurance, including up to $200 annually for eyewear and a $1,500 annual limit for dental services. Additionally, members benefit from up to 24 one-way transportation trips per year and covered over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits under the UHC Dual Complete TX-D004 (HMO-POS D-SNP) are partially covered, requiring no coinsurance alongside a copay of $2,230 per stay for acute care and $2,080 per stay for psychiatric care. While unlimited additional acute care days are included with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
UHC Dual Complete TX-D004 (HMO-POS D-SNP) covers outpatient services with no copays, though coinsurance ranges from 0% to 20% depending on the specific service. These covered benefits, which include outpatient hospital, ambulatory surgical center, substance abuse, and blood services, generally require prior authorization and referrals.
Partial Hospitalization See details
Partial hospitalization services are covered by the UHC Dual Complete TX-D004 (HMO-POS D-SNP) plan with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to receive this care.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the UHC Dual Complete TX-D004 (HMO-POS D-SNP) plan, with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any other health-related locations is not covered.
Emergency Services See details
UHC Dual Complete TX-D004 (HMO-POS 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 feature 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
UHC Dual Complete TX-D004 (HMO-POS D-SNP) covers primary care, specialist, and mental health services with no copay and 0% to 20% coinsurance, while chiropractic services are not covered. Physical, occupational, and speech therapies require no copay and 20% coinsurance, whereas telehealth and opioid treatment programs are available with no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by UHC Dual Complete TX-D004 (HMO-POS D-SNP), offering no copay and no coinsurance for annual physical exams, fitness benefits, weight management, and kidney disease education. Digital rectal exams and post-welcome visit EKGs require a 20% coinsurance and no copay, while several sub-services such as health education, personal emergency response systems, and nutritional benefits are not covered.
Hearing Services See details
Hearing services under UHC Dual Complete TX-D004 (HMO-POS D-SNP) include one routine hearing exam annually with no copay and 20% coinsurance, though fitting and evaluation exams are not covered. Up to two prescription hearing aids (up to a $1,500 limit every two years) and two OTC hearing aids are covered with no copay and no coinsurance, but inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by UHC Dual Complete TX-D004 (HMO-POS D-SNP) with no copay, no coinsurance, and no deductible for covered services. Coverage includes one routine eye exam per year and up to a $200 annual limit for contact lenses, eyeglass lenses, and frames, while upgrades, other eye exams, and bundled eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by UHC Dual Complete TX-D004 (HMO-POS D-SNP), excluding implant services and orthodontics, up to a $1,500 annual maximum. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive services are available with no copay and no coinsurance.
Home Infusion bundled Services See details
UHC Dual Complete TX-D004 (HMO-POS D-SNP) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by UHC Dual Complete TX-D004 (HMO-POS D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this care.
Medical Equipment See details
UHC Dual Complete TX-D004 (HMO-POS D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete TX-D004 (HMO-POS D-SNP) with prior authorization and referrals required. Lab services have no copay but require coinsurance, while diagnostic procedures require a copay and a 20% minimum coinsurance. Diagnostic radiological services have no copay or coinsurance, whereas therapeutic radiological and outpatient X-ray services have no copay and a 20% minimum coinsurance.
Home Health Services See details
UHC Dual Complete TX-D004 (HMO-POS D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by UHC Dual Complete TX-D004 (HMO-POS D-SNP) with no copay, though in practice only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services 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 TX-D004 (HMO-POS D-SNP) with no copay and no coinsurance. While the plan allows admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered, and prior authorization and referrals are required.
Other Services See details
UHC Dual Complete TX-D004 (HMO-POS D-SNP) partially covers other services, which includes over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and highly integrated services are not covered under this benefit.
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