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UHC Dual Complete MT-S001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete MT-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 MT-S001 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete MT-S001 (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 Montana. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete MT-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 MT-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 MT-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 MT-S001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $50.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.60. 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 MT-S001 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on the tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), the plan premium is $50.60. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete MT-S001 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Hospital stays have a $1025 copay, while outpatient services and primary care have coinsurance between 0% and 20%. Emergency services have a $110 copay, and ambulance services have a 20% coinsurance. Preventive services, including an annual physical, have no copay. Vision and dental services are covered, including eye exams and eyewear with no copay, and dental services with a 20% coinsurance. The plan also includes home health services with no copay, and medical equipment with some coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $1025 per admission or stay for Medicare-covered stays, and no copay for additional days for Inpatient Hospital-Acute for days 91-999. 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 include coverage for outpatient hospital services with a coinsurance between 0% and 20%, observation services with a 20% coinsurance, and ambulatory surgical center services with a coinsurance between 0% and 20%. Outpatient substance abuse services, including individual sessions with a coinsurance between 0% and 20% and group sessions with a 20% coinsurance, and outpatient blood services with a 20% coinsurance are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Dual Complete MT-S001 (PPO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the UHC Dual Complete MT-S001 (PPO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The UHC Dual Complete MT-S001 (PPO D-SNP) plan covers Primary Care Physician Services with a coinsurance of 0% to 20%, Chiropractic Services with a 20% coinsurance, Occupational Therapy Services with a 0% to 20% coinsurance, and Physician Specialist Services with a 0% to 20% coinsurance. Mental Health Specialty Services, including individual sessions, are covered with a 0% to 20% coinsurance, while group sessions have a 20% coinsurance. Podiatry Services have a 20% coinsurance, and a copay of $0. Other Health Care Professional, Psychiatric Services, and Physical Therapy and Speech-Language Pathology Services have a 0% to 20% coinsurance. Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, an annual physical exam with no copay, and additional preventive services with varying copays and coinsurance depending on the service. The plan also covers Fitness Benefit and Home and Bathroom Safety Devices and Modifications with no copay.
Hearing Services See details
Hearing services include routine hearing exams, with a coinsurance of at most 20% for routine hearing exams. Prescription hearing aids (all types) and OTC hearing aids are also covered, with no copay for OTC hearing aids. Fitting/Evaluation for Hearing Aid, 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. Eye exams have no copay, including routine eye exams. Eyewear has no copay, with a combined maximum of $350 per year for contact lenses, eyeglass lenses, and eyeglass frames, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Dual Complete MT-S001 (PPO D-SNP) plan covers dental services with a 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, and prosthodontics (fixed) are covered with no copay. However, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the UHC Dual Complete MT-S001 (PPO D-SNP) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. The plan requires prior authorization.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete MT-S001 (PPO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME and Prosthetics/Medical Supplies have a 15% coinsurance, and Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have a 15% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the UHC Dual Complete MT-S001 (PPO D-SNP) plan. Diagnostic Procedures/Tests and Therapeutic Radiological Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of at most 20% with a minimum of 0%. Lab Services have no copay, while outpatient X-ray services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete MT-S001 (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 not covered by the UHC Dual Complete MT-S001 (PPO D-SNP) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Dual Complete MT-S001 (PPO D-SNP) plan, but the cost share is not specified. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items and Meal Benefit coverage. Over-the-Counter (OTC) Items have no copay, and the plan offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit; however, Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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