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UHC Dual Complete PA-S001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete PA-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 PA-S001 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete PA-S001 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of Pennsylvania. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that UHC Dual Complete PA-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 PA-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 PA-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 PA-S001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.70. 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 $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 PA-S001 (PPO D-SNP) Medicare plan features an annual prescription drug deductible of $615. Under this plan, Tier 1 preferred generic drugs require no copay for 1-month or 3-month fills at standard pharmacies, as well as for 3-month fills through standard mail order. For other drug tiers, members generally pay a 25% coinsurance. This 25% coinsurance applies to Tier 2 generic and Tier 3 preferred brand drugs for 1-month and 3-month supplies, as well as to Tier 4 non-preferred and Tier 5 specialty drugs for 1-month supplies.
Additional Benefits
The UHC Dual Complete PA-S001 (PPO D-SNP) offers comprehensive medical coverage featuring no copays for primary care, specialist visits, and outpatient services, though coinsurance ranges from 0% to 20% depending on the service. For inpatient hospital stays, members pay a $1,920 copay per stay with no coinsurance, while emergency room visits carry a $115 copay that is waived if admitted. Additionally, home health and skilled nursing facility services are covered with no copay and no coinsurance. This plan also provides robust supplemental benefits, including preventive and comprehensive dental care up to a $1,500 annual limit with no copay and no coinsurance. Members can also take advantage of routine vision and hearing exams with no copay, alongside a $200 eyewear allowance and coverage for up to two hearing devices every two years. Other valuable perks include up to 36 one-way transportation trips per year, plus over-the-counter items and chronic meal benefits with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by UHC Dual Complete PA-S001 (PPO D-SNP) with a $1,920 copay per stay and no coinsurance for Medicare-covered acute and psychiatric admissions. Prior authorization is required, and while unlimited additional acute days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient Services for UHC Dual Complete PA-S001 (PPO D-SNP) are covered with no copay, with coinsurance ranging from 0% to 20% depending on the service. Covered benefits include outpatient hospital, ambulatory surgical center, blood, and outpatient substance abuse services, most of which require prior authorization.
Partial Hospitalization See details
UHC Dual Complete PA-S001 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UHC Dual Complete PA-S001 (PPO D-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance with no copay. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
UHC Dual Complete PA-S001 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, though the copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services have 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 PA-S001 (PPO D-SNP) covers primary care, specialist, and mental health services with no copay and coinsurance ranging from no coinsurance to 20%. Physical, occupational, and speech therapies have no copay and 20% coinsurance, while chiropractic services are not covered in practice.
Preventive Services See details
Preventive services under the UHC Dual Complete PA-S001 (PPO D-SNP) plan are partially covered, offering annual physical exams, kidney disease education, and fitness benefits with no copay and no coinsurance. While diabetes self-management training and glaucoma screenings have no copay, digital rectal exams and post-welcome visit EKGs require a 20% coinsurance, and several sub-services like health education and personal emergency response systems are not covered.
Hearing Services See details
Hearing Services under the UHC Dual Complete PA-S001 (PPO D-SNP) are partially covered with no deductible, offering routine exams once yearly with no copay and a 20% coinsurance. While fitting and evaluation exams, alongside inner, outer, and over-the-ear prescription aids are not covered, other prescription and OTC hearing aids are covered up to two devices every two years (with a $1,500 prescription limit) with no copay and no coinsurance.
Vision Services See details
Vision services are covered by UHC Dual Complete PA-S001 (PPO D-SNP) with no copay and no coinsurance, including one routine eye exam and a $200 combined annual allowance for contact lenses, eyeglass lenses, and frames. This benefit is partially covered, as 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 PA-S001 (PPO D-SNP), offering preventive and comprehensive care with no copay and no coinsurance up to a $1,500 annual limit, though implant services and orthodontics are not covered. Medicare-covered dental services are available with no copay and a 20% coinsurance, and prior authorization is required for some treatments.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Dual Complete PA-S001 (PPO D-SNP) with no copay, while associated Medicare Part B chemotherapy and other drugs require no copay and 0% (no coinsurance) to 20% coinsurance. Covered Part B insulin is available for a $35 copay and 0% (no coinsurance) to 20% coinsurance, with prior authorization and step therapy required.
Dialysis Services See details
UHC Dual Complete PA-S001 (PPO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
UHC Dual Complete PA-S001 (PPO D-SNP) covers medical equipment with no copay for durable medical equipment (DME), prosthetics, and diabetic supplies. A 20% coinsurance applies to DME, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete PA-S001 (PPO D-SNP) with prior authorization, featuring no copay for lab services and a copay with 20% coinsurance for diagnostic procedures. Radiological services require no copays, offering diagnostic radiology with no coinsurance, and therapeutic radiology and outpatient X-rays with a 20% coinsurance.
Home Health Services See details
The UHC Dual Complete PA-S001 (PPO D-SNP) plan covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by UHC Dual Complete PA-S001 (PPO D-SNP) with no copay, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered. These excluded rehabilitation services require a 20% coinsurance and prior authorization.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by UHC Dual Complete PA-S001 (PPO D-SNP) with no copay and no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Under this plan, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UHC Dual Complete PA-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 under this plan.
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