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UHC Dual Complete KY-S001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete KY-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 KY-S001 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete KY-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 Kentucky. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that UHC Dual Complete KY-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 KY-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 KY-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 KY-S001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.50. 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 KY-S001 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members benefit from no copay for standard pharmacy fills and standard mail order options. Tier 2 generic drugs require a 25% coinsurance for both standard pharmacy and standard mail order prescriptions. For higher-tier medications, including Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, the plan charges a consistent 25% coinsurance. This 25% coinsurance applies to standard pharmacy and standard mail order options for initial coverage. Knowing these fixed coinsurance rates and the deductible amount helps you plan your healthcare budget effectively with this UHC Dual Complete plan.
Additional Benefits
The UHC Dual Complete KY-S001 (PPO D-SNP) plan offers comprehensive coverage with no copay for primary care, outpatient services, and home health care, though some outpatient services may require up to 20% coinsurance. Inpatient hospital stays carry a $1,895 copay per stay with no coinsurance, while emergency room visits require a $115 copay that is waived if you are admitted. Skilled nursing facility care is covered with no copays or coinsurance, helping to keep recovery costs low. For routine wellness, the plan provides dental, vision, and hearing benefits with no copay, including up to $200 annually for eyewear and a $1,500 allowance for hearing aids. Medical equipment and dialysis services are covered with no copay and 20% coinsurance. Members also enjoy extra perks like no copays for over-the-counter items and up to 24 one-way trips per year to plan-approved locations.
Inpatient Hospital See details
UHC Dual Complete KY-S001 (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,895 copayment per stay and no coinsurance. This benefit is partially covered because non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered, though unlimited additional acute hospital days are covered with no copay.
Outpatient Services See details
UHC Dual Complete KY-S001 (PPO D-SNP) covers outpatient services with no copay and coinsurance ranging from no coinsurance up to 20% depending on the service. Prior authorization is required for outpatient hospital, ambulatory surgical center, substance abuse, and blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by UHC Dual Complete KY-S001 (PPO D-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
UHC Dual Complete KY-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 with no copay or coinsurance, providing up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
UHC Dual Complete KY-S001 (PPO D-SNP) covers emergency services with a $115 copay—waived if admitted to the hospital within 24 hours—and no coinsurance. Urgently needed services have a copay of $0 to $40 and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
UHC Dual Complete KY-S001 (PPO D-SNP) offers primary care, specialist, and therapy services with no copay and coinsurance ranging from 0% to 20%, while telehealth and opioid treatment services feature no copay and no coinsurance. Chiropractic services are not covered under this plan, but routine podiatry is covered for up to six visits per year with no copay and 20% coinsurance.
Preventive Services See details
UHC Dual Complete KY-S001 (PPO D-SNP) offers partially covered preventive services, featuring no copay and no coinsurance for annual physicals, kidney disease education, and select benefits like fitness programs. While some services like digital rectal exams and post-welcome visit EKGs require a 20% coinsurance, other options such as health education, personal emergency response systems, and nutritional/dietary benefits are not covered.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete KY-S001 (PPO D-SNP), offering one annual routine hearing exam with no copay and a 20% coinsurance, while fitting and evaluation exams are not covered. Up to two prescription or OTC hearing aids are covered every two years with no copay and no coinsurance—including a $1,500 maximum prescription allowance—though 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 KY-S001 (PPO D-SNP) with no copay, no coinsurance, and no deductible for one annual routine eye exam and eyewear up to a $200 yearly limit. Covered eyewear includes contact lenses, eyeglass lenses, and frames, while other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
UHC Dual Complete KY-S001 (PPO D-SNP) provides partially covered dental services with no copay and 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other preventive and comprehensive services up to a $1,500 annual limit. Covered services include cleanings, exams, and restorative care, but implant services and orthodontics are not covered.
Home Infusion bundled Services See details
UHC Dual Complete KY-S001 (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs feature no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete KY-S001 (PPO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by UHC Dual Complete KY-S001 (PPO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are covered with no copay, and prior authorization is required for most of these equipment benefits and services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete KY-S001 (PPO D-SNP) with prior authorization, featuring a copay and minimum 20% coinsurance for diagnostic procedures and tests, alongside lab services with no copay but applicable coinsurance. Radiological services require no copays, offering diagnostic radiology with no coinsurance, while therapeutic radiology and outpatient X-rays require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by UHC Dual Complete KY-S001 (PPO D-SNP) 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 KY-S001 (PPO D-SNP) with no copay, though only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by UHC Dual Complete KY-S001 (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required. The plan does not require a prior three-day inpatient hospital stay for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by UHC Dual Complete KY-S001 (PPO D-SNP), offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and other miscellaneous services are not covered, and the meal benefit requires prior authorization.
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