A non-government entity
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 2026, 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 4.5 out of 5 stars in 2026.
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 $41.50. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.30. 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:
Sign up for UHC Dual Complete MT-S001 (PPO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The UHC Dual Complete MT-S001 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members benefit from no copay for a 1-month or 3-month supply at standard pharmacies, as well as no copay for a 3-month supply through standard mail order. This makes starting on essential, preferred generic medications highly affordable. For other medication tiers, the plan transitions to a coinsurance model. Tier 2 generic and Tier 3 preferred brand drugs require a 25% coinsurance for both 1-month and 3-month supplies at standard pharmacies and standard mail order. Additionally, Tier 4 non-preferred drugs and Tier 5 specialty tier drugs carry a 25% coinsurance for a 1-month supply.
Additional Benefits
The UHC Dual Complete MT-S001 (PPO D-SNP) plan offers comprehensive healthcare coverage featuring no copays for primary care, specialist visits, and outpatient services, though coinsurance of up to 20% may apply. Inpatient hospital stays require a copay of $2,185 per acute stay and $2,080 per psychiatric stay, with no coinsurance. Emergency room visits carry a $115 copay, which is waived upon hospital admission, while worldwide emergency care and annual preventive physicals are covered with no copay. This plan also provides robust dental, vision, and hearing benefits, including no copays for routine eye exams, dental care up to a $2,000 annual limit, and hearing aids up to $2,200 every two years. Additionally, members benefit from no copays and no coinsurance for skilled nursing facility stays, home health services, and over-the-counter items. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
UHC Dual Complete MT-S001 (PPO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,185 copay per acute stay and a $2,080 copay per psychiatric stay. While unlimited additional acute days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
UHC Dual Complete MT-S001 (PPO D-SNP) covers outpatient services with no copays, though coinsurance and prior authorization requirements apply. Covered benefits, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, feature no copay and coinsurance ranging from no coinsurance to 20%.
Partial Hospitalization See details
UHC Dual Complete MT-S001 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UHC Dual Complete MT-S001 (PPO D-SNP) with a 20% coinsurance and no copay for prior-authorized ground and air ambulance rides. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
UHC Dual Complete MT-S001 (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 feature a copay ranging from $0 to $40 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
UHC Dual Complete MT-S001 (PPO D-SNP) covers primary care and specialist visits with no copay and 0% to 20% coinsurance. Physical, occupational, speech, and mental health therapies are covered with no copay and up to 20% coinsurance, while routine chiropractic care is not covered. Telehealth and opioid treatment services are available with no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered under UHC Dual Complete MT-S001 (PPO D-SNP), offering no copay and no coinsurance for annual physical exams, kidney disease education, fitness benefits, and in-home support. However, supplemental services such as health education, personal emergency response systems (PERS), and nutritional benefits are not covered.
Hearing Services See details
Hearing services are covered by UHC Dual Complete MT-S001 (PPO D-SNP), which offers one routine hearing exam annually with no copay and a 20% coinsurance, while fitting and evaluation exams are not covered. Prescription and OTC hearing aids are covered with no copay and no coinsurance up to a $2,200 maximum benefit every two years, though 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 MT-S001 (PPO D-SNP), offering routine eye exams and eyewear with no copay and no coinsurance. While contact lenses, eyeglass lenses, and frames are covered up to a $150 annual limit, other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental Services are partially covered under UHC Dual Complete MT-S001 (PPO D-SNP), as implant services and orthodontics are not covered. Most covered preventive and comprehensive services feature no copay and no coinsurance up to a $2,000 annual maximum, while Medicare-covered dental services require no copay and a 20% coinsurance.
Home Infusion bundled Services See details
UHC Dual Complete MT-S001 (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
UHC Dual Complete MT-S001 (PPO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
UHC Dual Complete MT-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 or inserts require a 20% coinsurance, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under UHC Dual Complete MT-S001 (PPO D-SNP) with prior authorization required. Diagnostic procedures and tests require a copay and 20% coinsurance, while lab services feature no copay. Radiological services require no copay, with a 20% coinsurance for therapeutic radiology and outpatient X-rays, and no coinsurance for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the UHC Dual Complete MT-S001 (PPO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
UHC Dual Complete MT-S001 (PPO D-SNP) offers Cardiac Rehabilitation Services with no copay and prior authorization required, but only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UHC Dual Complete MT-S001 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required. This benefit allows for admission with less than a three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under UHC Dual Complete MT-S001 (PPO D-SNP) are partially covered, providing over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance. Prior authorization is required for the meal benefit, and acupuncture is not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved