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UHC Dual Complete FL-Y4 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete FL-Y4 (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 FL-Y4 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete FL-Y4 (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 Florida. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that UHC Dual Complete FL-Y4 (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 FL-Y4 (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 FL-Y4 (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 FL-Y4 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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:
Sign up for UHC Dual Complete FL-Y4 (PPO D-SNP)
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Drug Coverage
The UHC Dual Complete FL-Y4 (PPO D-SNP) Medicare prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are highly accessible, requiring no copay for 1-month and 3-month supplies at standard pharmacies or for 3-month supplies filled through standard mail order. For Tier 2 generic and Tier 3 preferred brand medications, members are responsible for a 25% coinsurance on 1-month and 3-month supplies at standard pharmacies and standard mail order. Tier 4 non-preferred drugs and Tier 5 specialty drugs also require a 25% coinsurance for 1-month supplies at standard pharmacies and through standard mail order.
Additional Benefits
The UHC Dual Complete FL-Y4 (PPO D-SNP) plan offers comprehensive medical coverage featuring no copay for primary care, specialist visits, and outpatient services, though some specialist and outpatient care may require up to a 20% coinsurance. Inpatient hospital stays require a $2,020 copay per admission with no coinsurance, while emergency room visits carry a $115 copay that is waived upon immediate admission. Additionally, many essential services like home health care, skilled nursing facility stays, and diagnostic lab tests are covered with no copay and no coinsurance. This plan also provides robust supplemental benefits, including dental, vision, and hearing coverage with no copay and no coinsurance for routine services. Dental benefits cover preventive and comprehensive care up to a $2,000 annual limit, while vision benefits include a $250 annual allowance for eyewear with no deductible. Furthermore, members can access up to two hearing aids every two years with a $2,200 benefit limit and enjoy up to 48 free one-way transportation trips to plan-approved locations each year.
Inpatient Hospital See details
UHC Dual Complete FL-Y4 (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $2,020 copay per admission and no coinsurance, subject to prior authorization. This benefit is partially covered as upgrades, non-Medicare-covered stays, 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 FL-Y4 (PPO D-SNP) covers outpatient services with no copay, though prior authorization is required for most of these benefits. Coinsurance ranges from no coinsurance to 20% for outpatient hospital, ambulatory surgical center, and individual substance abuse sessions, while observation, group substance abuse, and blood services require a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by UHC Dual Complete FL-Y4 (PPO D-SNP) with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UHC Dual Complete FL-Y4 (PPO D-SNP), requiring a 20% coinsurance and no copay for ground and air ambulance transport. Transportation services are partially covered with no copay or coinsurance for up to 48 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
UHC Dual Complete FL-Y4 (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 feature a copay of $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 FL-Y4 (PPO D-SNP) covers primary care, specialist, and mental health services with no copay and 0% to 20% coinsurance, while telehealth and opioid treatment feature no copay and no coinsurance. Physical, occupational, and speech therapies are covered with no copay and 20% coinsurance, and routine chiropractic care is covered for up to 12 visits with no copay and no coinsurance, though other chiropractic services are not covered.
Preventive Services See details
UHC Dual Complete FL-Y4 (PPO D-SNP) offers partially covered preventive services, with most benefits—including annual physical exams, fitness programs, and in-home support—requiring no copay and no coinsurance, while digital rectal exams and post-welcome visit EKGs require a 20% coinsurance and no copay. Non-covered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
UHC Dual Complete FL-Y4 (PPO D-SNP) partially covers hearing services with no copays and no coinsurance, offering one routine exam yearly and up to two OTC or prescription hearing aids every two years with a $2,200 benefit limit. Prior authorization is required for exams and prescription aids, while fitting/evaluation exams and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
UHC Dual Complete FL-Y4 (PPO D-SNP) provides partially covered vision services with no copay, no coinsurance, and no deductible, which includes one routine eye exam yearly and a combined $250 annual limit for contact lenses, upgrades, and eyeglasses (lenses and frames). Other eye exam services, separate eyeglass lenses, and separate eyeglass frames are not covered by this plan.
Dental Services See details
UHC Dual Complete FL-Y4 (PPO D-SNP) offers partially covered dental services with no copay and 20% coinsurance for Medicare-covered dental care, and no copay and no coinsurance for preventive and comprehensive services up to a $2,000 annual maximum. Implant services and orthodontics are not covered under this plan, and prior authorization is required for certain treatments.
Home Infusion bundled Services See details
UHC Dual Complete FL-Y4 (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance, while Medicare Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
UHC Dual Complete FL-Y4 (PPO D-SNP) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by UHC Dual Complete FL-Y4 (PPO D-SNP) with no copay and 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, though prior authorization is required. Diabetic supplies are covered with no copay and no coinsurance from specified manufacturers, while diabetic therapeutic shoes and inserts require a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete FL-Y4 (PPO D-SNP) with prior authorization, featuring no copay and no coinsurance for diagnostic radiology, and no copay for lab services. Diagnostic procedures require a copay and 20% minimum coinsurance, while outpatient X-rays and therapeutic radiology require a 20% minimum coinsurance with no copay.
Home Health Services See details
Home health services are covered under the UHC Dual Complete FL-Y4 (PPO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the UHC Dual Complete FL-Y4 (PPO D-SNP) with no copay and no coinsurance, although some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD services are not covered and require 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by UHC Dual Complete FL-Y4 (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under the UHC Dual Complete FL-Y4 (PPO D-SNP) plan are partially covered, offering over-the-counter items and chronic illness meal benefits with no copay and no coinsurance, though prior authorization is required for meals. Acupuncture and highly integrated dual-eligible services are not covered under this benefit.
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