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UHC Dual Complete LA-S4 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete LA-S4 (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 LA-S4 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete LA-S4 (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 Louisiana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that UHC Dual Complete LA-S4 (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 LA-S4 (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 LA-S4 (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 LA-S4 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $55.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.20. 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 LA-S4 (PPO D-SNP) plan has a defined standard drug benefit. The plan has a deductible of $590.00. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. Once you reach that amount, you enter the next coverage phase. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The UHC Dual Complete LA-S4 (PPO D-SNP) plan offers a range of benefits with varying costs. You'll pay a $1260 copay for inpatient hospital stays, with no copay for additional days, and a $110 copay for emergency services. Many services have no copay, including preventive services, vision exams and eyewear, dental services, home health, and OTC items. Outpatient services, primary care, and medical equipment have coinsurance costs between 0-20%, with specific services like ambulance and some diagnostic procedures having coinsurance costs as well. The plan covers hearing and dental services, and offers a meal benefit, but does not cover cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, you will pay a copay of $1260 per admission or stay, and additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including all outpatient hospital services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a coinsurance between 0% and 20%, observation services have a 20% coinsurance, and ASC services have a coinsurance between 0% and 20%. Individual sessions for outpatient substance abuse have a coinsurance between 0% and 20%, while group sessions have a 20% coinsurance. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete LA-S4 (PPO D-SNP) plan with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Dual Complete LA-S4 (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered with no copay, up to 60 one-way trips per year. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UHC Dual Complete LA-S4 (PPO D-SNP) plan. For Emergency Services, there is a $110 copay, and no coinsurance. For Urgently Needed Services, the copay ranges from $0 to $45, and there is no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services have a coinsurance between 0% and 20%. Chiropractic services have a 20% coinsurance. Individual and Group Sessions for Mental Health and Psychiatric Services, and Routine Foot Care have a coinsurance between 0% and 20%. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a copay of $0.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additional preventive services, such as Diabetes Self-Management Training and Barium Enemas, are covered with no copay, while Digital Rectal Exams and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services are covered, including hearing exams with a coinsurance of at most 20% for routine hearing exams and no copay, and prescription hearing aids with a maximum benefit of $2200 per year. OTC hearing aids have no copay, and fitting/evaluation for hearing aids, as well as prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include routine eye exams with no copay, and eyewear with no copay. Eyeglass lenses and frames are covered, with one pair of each covered every year, and contact lenses are covered with no limits. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis, fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery, all with no copay, but with varying limitations on the number of visits and periodicity.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the UHC Dual Complete LA-S4 (PPO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay with a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the UHC Dual Complete LA-S4 (PPO D-SNP) plan. Prior authorization is required, and you will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying cost-sharing. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the UHC Dual Complete LA-S4 (PPO D-SNP) plan. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a coinsurance of at most 20% with a minimum coinsurance of 0%, while Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20% with a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete LA-S4 (PPO D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the UHC Dual Complete LA-S4 (PPO D-SNP) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Dual Complete LA-S4 (PPO D-SNP) plan, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and the copay information is not provided in this summary.
Other Services See details
The UHC Dual Complete LA-S4 (PPO D-SNP) plan covers Over-the-Counter (OTC) items and a meal benefit. OTC items have no copay, while the meal benefit also has no copay and requires prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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