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UHC Dual Complete NC-S2 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete NC-S2 (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 NC-S2 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete NC-S2 (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 North Carolina. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that UHC Dual Complete NC-S2 (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 NC-S2 (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 NC-S2 (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 NC-S2 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.20. 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:
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Drug Coverage
The UHC Dual Complete NC-S2 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For those enrolled, Tier 1 preferred generic drugs are highly affordable, offering no copay for a 1-month or 3-month supply at standard pharmacies and standard mail order. This makes managing essential medications highly cost-effective from day one. For Tier 2 generic, Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, members are responsible for a 25% coinsurance fee through standard pharmacy and standard mail order services. Understanding these copay and coinsurance structures helps you accurately estimate your out-of-pocket prescription costs under this Medicare plan.
Additional Benefits
The UHC Dual Complete NC-S2 (PPO D-SNP) plan offers robust healthcare coverage, featuring no copay for primary care, specialist visits, and outpatient hospital services, though coinsurance of up to 20% may apply. Inpatient hospital stays require a $2,070 copay per admission with no coinsurance, whereas emergency room visits carry a $115 copay that is waived upon hospital admission. Additionally, members can access preventive services, telehealth, and home health care with no copays or coinsurance. Essential supplemental benefits like routine vision exams and eyewear are covered with no copays or coinsurance, including a $150 annual eyewear allowance. While routine dental is not covered, Medicare-covered dental, dialysis, and medical equipment are available with no copay and a 20% coinsurance. The plan also supports daily living by offering no copay for up to 36 one-way transportation trips annually and up to two hearing devices every two years.
Inpatient Hospital See details
UHC Dual Complete NC-S2 (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $2,070 copay per admission and no coinsurance, though prior authorization is required. This benefit is partially covered as it excludes upgrades, non-Medicare-covered stays, and additional psychiatric days, but it does offer unlimited additional acute days with no copay.
Outpatient Services See details
UHC Dual Complete NC-S2 (PPO D-SNP) covers outpatient services with no copays, with coinsurance ranging from no coinsurance up to 20% depending on the service. These covered benefits include outpatient hospital, ambulatory surgical center, substance abuse, and blood services, most of which require prior authorization.
Partial Hospitalization See details
Partial hospitalization is covered by the UHC Dual Complete NC-S2 (PPO D-SNP) plan with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
UHC Dual Complete NC-S2 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
UHC Dual Complete NC-S2 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay of $0 to $40 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copays and no coinsurance.
Primary Care See details
UHC Dual Complete NC-S2 (PPO D-SNP) covers primary care, specialist, mental health, and psychiatric services with no copay and 0% to 20% coinsurance, though chiropractic services are not covered. Physical, occupational, speech, and routine podiatry services are covered with no copay and 20% coinsurance. Telehealth and opioid treatment services are available with no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by UHC Dual Complete NC-S2 (PPO D-SNP), with no copays and no coinsurance for annual physicals, fitness benefits, and kidney disease education. Digital rectal exams and post-welcome visit EKGs require a 20% coinsurance, while other sub-services like health education, medical nutrition therapy, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete NC-S2 (PPO D-SNP), which includes one annual routine hearing exam with no copay and 20% coinsurance, though fitting and evaluation exams are not covered. Prescription and OTC hearing aids are covered with no copay and no coinsurance for up to two devices every two years (with a $1,500 maximum coverage limit for prescription aids), but inner ear, outer ear, and over-the-ear prescription models are excluded.
Vision Services See details
UHC Dual Complete NC-S2 (PPO D-SNP) provides partially covered vision services with no copays, no coinsurance, and no deductibles, including a $150 annual limit for eyewear. While routine eye exams, contact lenses, individual eyeglass lenses, and frames are covered, other eye exam services, eyeglasses (lenses and frames) as a combined package, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by UHC Dual Complete NC-S2 (PPO D-SNP), which offers Medicare-covered dental services with no copay and a 20% coinsurance, subject to prior authorization. Routine and comprehensive sub-services—including oral exams, cleanings, x-rays, fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics—are not covered by the plan.
Home Infusion bundled Services See details
UHC Dual Complete NC-S2 (PPO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete NC-S2 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment benefits under UHC Dual Complete NC-S2 (PPO D-SNP) are covered and require prior authorization. Durable medical equipment, prosthetics, and medical supplies feature no copay and a 20% coinsurance, while diabetic supplies have no copay and diabetic therapeutic shoes or inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by UHC Dual Complete NC-S2 (PPO D-SNP) with prior authorization. Diagnostic tests require a copay and 20% coinsurance, lab services have no copay but are subject to coinsurance, and radiological services have no copay, featuring no coinsurance for diagnostic radiology and 20% coinsurance for therapeutic and X-ray services.
Home Health Services See details
UHC Dual Complete NC-S2 (PPO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
UHC Dual Complete NC-S2 (PPO D-SNP) covers some Cardiac Rehabilitation Services with no copay and prior authorization, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by UHC Dual Complete NC-S2 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required. While the plan covers admission with less than a three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under the UHC Dual Complete NC-S2 (PPO D-SNP) plan are partially covered, featuring no copay and no coinsurance for over-the-counter items and chronic illness meal benefits, which require prior authorization. Acupuncture and other additional services are not covered under this benefit.
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