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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 2025, 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 3.5 out of 5 stars in 2025.
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 $51.20. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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 NC-S001 (PPO D-SNP) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay the costs for your drugs as defined by the plan. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). If you qualify for LIS, your monthly premium for Part D drugs is $51.20.
Additional Benefits
The UHC Dual Complete NC-S001 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. You'll pay a $1855 copay for inpatient hospital stays, and 0-20% coinsurance for outpatient services, with additional copays or coinsurance for services like partial hospitalization, ambulance, and emergency care. Preventive, vision, and dental services have no copay. Other services like hearing exams, home health, and lab services are covered with no copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $1855.00 per admission or stay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all Outpatient Hospital Services, are covered by this plan. Outpatient Hospital Services have a coinsurance of 0% - 20%, Observation Services have a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services have a coinsurance between 0% and 20%. Outpatient Substance Abuse Services are covered, with individual sessions having a coinsurance between 0% and 20%, and group sessions having a 20% coinsurance. Outpatient Blood Services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Dual Complete NC-S001 (PPO 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 for up to 36 one-way trips per year via taxi or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have varying cost-sharing amounts. Emergency Services require a $110 copay, and no coinsurance, while Urgently Needed Services have a copay between $0 and $45, and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have no copay and no coinsurance.
Primary Care See details
The UHC Dual Complete NC-S001 (PPO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy, and Psychiatric Services have a coinsurance of 0-20%, while Chiropractic Services and Routine Foot Care have a 20% coinsurance. Additional Telehealth Benefits and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services include no copay for an annual physical exam, and also covers additional preventive services like fitness benefits, and home and bathroom safety devices with no copay. Glaucoma screenings, Diabetes Self-Management Training, and Barium Enemas have no copay. Digital Rectal Exams and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
The UHC Dual Complete NC-S001 (PPO D-SNP) plan covers hearing exams with at most 20% coinsurance and fitting/evaluation for hearing aids are not covered. Prescription hearing aids are covered, with a maximum benefit of $2500 every year, and OTC hearing aids are covered with no copay.
Vision Services See details
The UHC Dual Complete NC-S001 (PPO D-SNP) plan covers vision services including eye exams, contact lenses, eyeglass lenses, and eyeglass frames with no copay. However, the plan does not cover eyeglasses (lenses and frames) or upgrades.
Dental Services See details
The UHC Dual Complete NC-S001 (PPO D-SNP) plan covers Medicare Dental Services with 20% coinsurance. Other Dental Services, including oral exams, dental x-rays, other diagnostic and preventive services, are covered with no copay, and a maximum benefit of $2500 per year. Orthodontic Services and Implant services are not covered.
Home Infusion bundled Services See details
The UHC Dual Complete NC-S001 (PPO D-SNP) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the UHC Dual Complete NC-S001 (PPO D-SNP) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
The UHC Dual Complete NC-S001 (PPO D-SNP) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests and Therapeutic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete NC-S001 (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 not covered by the UHC Dual Complete NC-S001 (PPO D-SNP) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays, and non-Medicare-covered stays are not covered. Prior authorization is required, and the cost sharing details are not provided in this summary.
Other Services See details
Under Other Services, this plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay, while 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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