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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 2025, 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 3.5 out of 5 stars in 2025.
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 $20.30. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.80. 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 FL-Y4 (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 will enter the next coverage phase. This plan's premium may be reduced if you qualify for the low-income subsidy, and the Part D premium will be $20.30.
Additional Benefits
The UHC Dual Complete FL-Y4 (PPO D-SNP) plan offers comprehensive coverage with a range of benefits. You'll find no copay for many services, including routine hearing exams, vision exams, and many dental services. The plan also covers a wide array of other services like inpatient hospital stays, outpatient services, emergency services, and home health services. This plan includes coverage for prescription hearing aids with a maximum benefit of $3,200 per year, as well as eyewear benefits up to $450 per year. You will also find coverage for ambulance and transportation services, medical equipment, and diagnostic and radiological services. While some services may have a copay or coinsurance, many essential services are available with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. You will pay a copay of $1580 per admission or stay for Medicare-covered stays, and no copay for additional days for Inpatient Hospital-Acute. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered with a coinsurance between 0% and 20%, and observation services are covered with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services are covered with a coinsurance between 0% and 20%, and Outpatient Substance Abuse Services are covered with a coinsurance between 0% and 20%. Outpatient Blood Services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the UHC Dual Complete FL-Y4 (PPO D-SNP) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance. Transportation Services to plan-approved health-related locations are covered with no copay and up to 48 one-way trips per year via taxi or medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered by the UHC Dual Complete FL-Y4 (PPO D-SNP) plan. Emergency services have a $110 copay, while urgently needed services have a copay between $0 and $45, and worldwide emergency services, worldwide urgent coverage, and worldwide emergency transportation each have no copay.
Primary Care See details
The UHC Dual Complete FL-Y4 (PPO D-SNP) plan covers primary care physician services with a coinsurance between 0% and 20%, and chiropractic services with no copay. The plan also covers occupational therapy services with a coinsurance between 0% and 20%. Additionally, the plan 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 Medicare-covered services with no copay, an annual physical exam with no copay, additional services with varying copays, and kidney disease education with no copay. Other preventive services like glaucoma screenings, diabetes self-management training, and barium enemas have no copay, while digital rectal exams and EKGs following a welcome visit have 20% coinsurance. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are covered once per year with no copay. Prescription hearing aids are covered with a maximum plan benefit of $3,200 per year, and OTC hearing aids are covered with no copay. Fitting/evaluation for hearing aids, 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 include eye exams and eyewear benefits. Eye exams have no copay, including routine eye exams, but eyewear benefits have a combined maximum of $450 per year, with no copay for contact lenses, eyeglasses (lenses and frames), and upgrades. However, eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a 20% coinsurance. Other Dental Services include oral exams, dental x-rays, and other diagnostic dental services with no copay, and prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no copay, but implant services and orthodontics are not covered.
Home Infusion bundled Services See details
The UHC Dual Complete FL-Y4 (PPO D-SNP) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the UHC Dual Complete FL-Y4 (PPO D-SNP) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a coinsurance of at most 20%.
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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a coinsurance for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
Under "Other Services," acupuncture and services for Dual Eligible SNPs with Highly Integrated Services are not covered. Over-the-counter (OTC) items and meal benefits are covered with no copay, and some details are available for each.
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