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UHC Dual Complete WV-S001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete WV-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 WV-S001 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete WV-S001 (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 West Virginia. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that UHC Dual Complete WV-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 WV-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 WV-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 WV-S001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.00. 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 $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 WV-S001 (PPO D-SNP) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members benefit from no copay for 1-month and 3-month supplies filled at standard pharmacies or through standard mail order. This structure provides a highly affordable option for individuals who primarily rely on preferred generic medications. For other drug tiers, the plan requires a 25% coinsurance. This 25% coinsurance applies to Tier 2 generic drugs, Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs for standard pharmacy and standard mail order fills. Reviewing these cost-sharing details helps you determine your potential out-of-pocket expenses for prescriptions under this plan.
Additional Benefits
The UHC Dual Complete WV-S001 (PPO D-SNP) plan offers comprehensive medical coverage with no copays for primary care visits, home health services, and skilled nursing facility care. Inpatient hospital stays require a $2,070 copayment per stay with no coinsurance, while outpatient services generally feature no copays and coinsurance ranging from 0% to 20%. Emergency care is accessible with a $115 copay, which is waived upon admission, and urgent care copays range from $0 to $40. This plan also provides valuable supplemental benefits, including preventive and comprehensive dental care with no copay or coinsurance up to a $2,000 annual limit. Routine vision exams and eyewear are covered with no copay or coinsurance up to $150 annually, and hearing services include up to two hearing aids every two years with no copay. Additionally, members benefit from no copays on diabetic supplies, over-the-counter items, and home meals, though standard medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by UHC Dual Complete WV-S001 (PPO D-SNP) with a $2,070 copayment per stay and no coinsurance for Medicare-covered acute and psychiatric stays. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
UHC Dual Complete WV-S001 (PPO D-SNP) covers outpatient services with no copays, though coinsurance and prior authorization requirements apply. Outpatient hospital, ambulatory surgical center, and outpatient substance abuse services have no copay and 0% to 20% coinsurance, while outpatient blood services require no copay and a 20% coinsurance with no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the UHC Dual Complete WV-S001 (PPO D-SNP) plan with a $55.00 copay and no coinsurance, requiring prior authorization.
Ambulance and Transportation Services See details
UHC Dual Complete WV-S001 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
UHC Dual Complete WV-S001 (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 require a copay of $0 to $40 with no coinsurance, while worldwide emergency, urgent, and transportation services are fully covered with no copays or coinsurance.
Primary Care See details
Primary care benefits are covered by UHC Dual Complete WV-S001 (PPO D-SNP) with no copays and coinsurance ranging from no coinsurance to 20% depending on the service. While most specialist, therapy, and mental health services are covered, some chiropractic services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by UHC Dual Complete WV-S001 (PPO D-SNP), featuring no copay and no coinsurance for annual physical exams, kidney disease education, and select supplemental benefits like fitness and weight management. However, several sub-services including health education, medical nutrition therapy, and personal emergency response systems are not covered, while certain other services like digital rectal exams and EKGs require a 20% coinsurance.
Hearing Services See details
UHC Dual Complete WV-S001 (PPO D-SNP) offers partially covered hearing services, featuring annual routine hearing exams with a 20% coinsurance and no copay, plus up to two OTC or prescription hearing aids every two years with no copay and no coinsurance. While prescription aids are covered up to a $2,200 limit, fitting and evaluation exams, along with inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services are partially covered by UHC Dual Complete WV-S001 (PPO D-SNP) with no deductible, no copay, and no coinsurance, featuring one routine eye exam and up to $150 annually for eyewear. Other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered under this plan.
Dental Services See details
UHC Dual Complete WV-S001 (PPO D-SNP) offers partially covered dental services, as implant services and orthodontics are not covered. Covered preventive and comprehensive dental services have no copay and no coinsurance up to a $2,000 annual maximum for both in- and out-of-network care, while Medicare-covered dental services require no copay and a 20% coinsurance.
Home Infusion bundled Services See details
UHC Dual Complete WV-S001 (PPO D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 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 WV-S001 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
UHC Dual Complete WV-S001 (PPO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under UHC Dual Complete WV-S001 (PPO D-SNP) with prior authorization required. Lab services and diagnostic radiological services are provided with no copay and no coinsurance, while diagnostic procedures, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance, with a copay also applying to diagnostic procedures.
Home Health Services See details
Home Health Services are covered by UHC Dual Complete WV-S001 (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by UHC Dual Complete WV-S001 (PPO D-SNP) with no copay and prior authorization required, though only some services are covered. Specifically, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete WV-S001 (PPO D-SNP) provides partially covered Skilled Nursing Facility (SNF) services with no copayment or coinsurance, though prior authorization is required. While the plan allows admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UHC Dual Complete WV-S001 (PPO D-SNP) partially covers other services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture and highly integrated services for dual eligible SNPs are not covered under this plan, and prior authorization is required for the meal benefit.
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