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UHC Dual Complete NC-S001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete NC-S001 (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 NC-S001 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete NC-S001 (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 North Carolina. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that UHC Dual Complete NC-S001 (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 NC-S001 (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 NC-S001 (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 NC-S001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.20. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.50. 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 NC-S001 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using standard pharmacies for a 1-month or 3-month supply, or standard mail order for a 3-month supply. This makes filling essential everyday medications highly affordable. For Tier 2 generic and Tier 3 preferred brand drugs, the plan requires a 25% coinsurance for standard pharmacy and standard mail order fills. Tier 4 non-preferred drugs and Tier 5 specialty drugs also incur a 25% coinsurance for a 1-month supply at standard pharmacies and through standard mail order. This consistent cost-sharing structure helps you easily plan for your medication expenses.
Additional Benefits
The UHC Dual Complete NC-S001 (PPO D-SNP) offers robust medical coverage featuring no copay for primary care and specialist visits, with coinsurance ranging from 0% to 20%. Inpatient hospital stays require a $2,050 copay per admission with no coinsurance, while outpatient and home health services are covered with no copays. Emergency care is available with a $115 copay that is waived upon admission, and urgent care features no coinsurance and low to no copays. Supplemental benefits include dental coverage with a $2,000 annual limit and no copay or coinsurance for preventive services. Vision and hearing benefits feature routine annual exams with no copays, alongside allowances of up to $150 for eyewear and up to $1,500 for hearing aids. Additionally, the plan covers up to 24 one-way transportation trips per year and offers over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
UHC Dual Complete NC-S001 (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $2050 copay per admission and no coinsurance. While unlimited additional acute stay days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by UHC Dual Complete NC-S001 (PPO D-SNP) feature no copays, with coinsurance ranging from no coinsurance up to 20% depending on the service. Covered care includes outpatient hospital, ambulatory surgical center, substance abuse, and blood services, which generally require prior authorization.
Partial Hospitalization See details
UHC Dual Complete NC-S001 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
UHC Dual Complete NC-S001 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, but trips to any health-related location are not covered.
Emergency Services See details
UHC Dual Complete NC-S001 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no coinsurance and a copay ranging from no copay to $40. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance.
Primary Care See details
UHC Dual Complete NC-S001 (PPO D-SNP) covers primary care and specialist visits with no copay and 0% to 20% coinsurance, while physical, occupational, and speech therapies require no copay and 20% coinsurance. Chiropractic services are partially covered, with routine chiropractic care not covered, and telehealth and opioid treatment services are available with no copay and no coinsurance.
Preventive Services See details
UHC Dual Complete NC-S001 (PPO D-SNP) covers annual physical exams, kidney disease education, and supplemental benefits like fitness programs with no copay and no coinsurance. Additional preventive services are only partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, smoking cessation, disease management, telemonitoring, remote access, and counseling. However, certain services like digital rectal exams and post-welcome visit EKGs require a 20% coinsurance.
Hearing Services See details
UHC Dual Complete NC-S001 (PPO D-SNP) partially covers hearing services, offering one routine hearing exam annually with no copay and 20% coinsurance, though fitting and evaluation exams are not covered. Up to two OTC or prescription hearing aids are covered every two years with no copay and no coinsurance (up to a $1,500 combined limit), but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
UHC Dual Complete NC-S001 (PPO D-SNP) offers partially covered vision services with no copay and no coinsurance, including one routine eye exam yearly and a $150 annual limit for contacts, lenses, and frames. Other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by UHC Dual Complete NC-S001 (PPO D-SNP), which offers an annual maximum benefit of $2,000 for both in-network and out-of-network care. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, though implant services and orthodontics are not covered.
Home Infusion bundled Services See details
UHC Dual Complete NC-S001 (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by UHC Dual Complete NC-S001 (PPO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
UHC Dual Complete NC-S001 (PPO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies feature no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete NC-S001 (PPO D-SNP), with prior authorization required. Diagnostic radiological services feature no copay and no coinsurance, lab services have no copay, and other diagnostic tests, therapeutic radiology, and outpatient X-rays require a 20% coinsurance and applicable copayments.
Home Health Services See details
UHC Dual Complete NC-S001 (PPO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under UHC Dual Complete NC-S001 (PPO D-SNP) with no copay and require prior authorization. While 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 NC-S001 (PPO D-SNP) with no copay and no coinsurance, though 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
UHC Dual Complete NC-S001 (PPO D-SNP) provides partial coverage for other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for the meal benefit, and acupuncture is not covered.
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