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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 2025, 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 3.5 out of 5 stars in 2025.
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 $31.50. 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 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 PA-S001 (PPO 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 (LIS), you will pay $31.50. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete PA-S001 (PPO D-SNP) plan offers comprehensive coverage, including inpatient hospital stays with a $2,000 copay, outpatient services with varying coinsurance, and emergency services with a $110 copay. This plan provides additional benefits such as no copay for primary care telehealth, and preventive services, as well as coverage for hearing, vision, and dental services. You'll also find coverage for ambulance and transportation services, and home health services with no copay.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, you will pay a $2,000 copay per admission or stay, and additional days between days 91-999 have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, nor are additional days or non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 0% to 20% coinsurance, Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a 0% to 20% coinsurance, and Outpatient Substance Abuse Services with a 0% to 20% coinsurance for individual sessions and a 20% coinsurance for group sessions. Outpatient Blood Services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete PA-S001 (PPO D-SNP) plan, with a $55 copay and prior authorization required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services to plan-approved health-related locations have no copay, and covers up to 36 one-way trips per year via taxi or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UHC Dual Complete PA-S001 (PPO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Services have no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, or Worldwide Emergency Transportation.
Primary Care See details
The UHC Dual Complete PA-S001 (PPO D-SNP) plan covers primary care physician services with a coinsurance between 0% and 20%, chiropractic services with 20% coinsurance (routine care is not covered), and occupational therapy services with a coinsurance between 0% and 20%. The plan also covers physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits with no copay, and opioid treatment program services with no copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services, with no copay for services such as Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas. Digital Rectal Exams and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services include coverage for hearing exams, with a coinsurance of at most 20% for routine hearing exams, and prescription hearing aids, with no copay for OTC hearing aids. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear. Routine eye exams have no copay, and you can get one exam every year. Eyewear is covered with a combined maximum of $300 every year, and contact lenses, eyeglass lenses, and eyeglass frames are covered with no copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance. Other services, such as Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered under this plan. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Diabetic Supplies have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic procedures/tests and diagnostic radiological services have a coinsurance of at most 20%, while lab services have no copay and outpatient x-ray services and therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home health services are covered by the UHC Dual Complete PA-S001 (PPO D-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered by this plan.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the UHC Dual Complete PA-S001 (PPO D-SNP) plan. Although the plan covers some cardiac and pulmonary rehabilitation services, the specific services listed (Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C, and additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items and a Meal Benefit, with no copay. 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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