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UHC Dual Complete SD-Q1 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete SD-Q1 (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 SD-Q1 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete SD-Q1 (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 South Dakota. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that UHC Dual Complete SD-Q1 (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 SD-Q1 (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 SD-Q1 (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 SD-Q1 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 SD-Q1 (PPO D-SNP)
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Drug Coverage
The UHC Dual Complete SD-Q1 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for standard pharmacy fills and standard three-month mail orders. Tier 2 generic drugs require a 25% coinsurance for standard pharmacy fills and standard three-month mail orders. For Tier 3 preferred brand drugs, members pay a 25% coinsurance for standard pharmacy and standard mail-order fills. Tier 4 non-preferred drugs and Tier 5 specialty tier medications both carry a 25% coinsurance for one-month supplies at standard pharmacies and standard mail order. This clear prescription drug coverage helps you easily understand your out-of-pocket costs under this plan.
Additional Benefits
The UHC Dual Complete SD-Q1 (PPO D-SNP) plan offers comprehensive coverage for core medical needs, featuring no copay for primary care, specialist visits, outpatient hospital services, and home health care. Inpatient hospital stays require a $1,970 copay per admission with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Most outpatient services and medical equipment feature no copay, though you may be responsible for a coinsurance ranging from 0% to 20% depending on the specific service. For everyday wellness, the plan provides preventive dental, routine vision exams, and eyewear with no copay or coinsurance, alongside up to 24 one-way transportation trips per year to approved locations with no copay or coinsurance. You also benefit from no copay for prescription hearing aids up to a $1,500 maximum every two years, as well as over-the-counter items and chronic-illness meals with no copay or coinsurance. These additional perks help minimize your out-of-pocket costs for essential daily health and wellness needs.
Inpatient Hospital See details
UHC Dual Complete SD-Q1 (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,970 copay per admission and no coinsurance, requiring prior authorization. Unlimited additional acute 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 SD-Q1 (PPO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, substance abuse, and blood services—with no copays. Depending on the specific service, coinsurance ranges from 0% to 20%, and prior authorization is required.
Partial Hospitalization See details
Partial hospitalization services are covered by UHC Dual Complete SD-Q1 (PPO D-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the UHC Dual Complete SD-Q1 (PPO D-SNP) plan, featuring a 20% coinsurance and no copay for ground and air ambulance trips. Transportation is partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by UHC Dual Complete SD-Q1 (PPO D-SNP) with a $115 copay and no coinsurance, which is 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 SD-Q1 (PPO D-SNP) covers primary care, specialist, and mental health services with no copay and 0% to 20% coinsurance, while telehealth and opioid treatments feature no copay and no coinsurance. Physical, occupational, and speech therapies, along with routine podiatry, require no copay and 20% coinsurance, but chiropractic services are not covered.
Preventive Services See details
UHC Dual Complete SD-Q1 (PPO D-SNP) covers preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, diabetes self-management, and glaucoma screenings, though digital rectal exams and post-Welcome Visit EKGs require a 20% coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness, weight management, in-home support, caregiver support, and home safety, while health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, smoking cessation, disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
UHC Dual Complete SD-Q1 (PPO D-SNP) partially covers hearing services, offering one routine hearing exam per year 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, providing up to two hearing aids every two years with a $1,500 maximum benefit for prescription devices, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by UHC Dual Complete SD-Q1 (PPO D-SNP) with no copay and no coinsurance for routine eye exams, contact lenses, eyeglass lenses, and frames, up to a combined $150 annual limit. Prior authorization is required for exams, and other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
UHC Dual Complete SD-Q1 (PPO D-SNP) covers Medicare dental services with no copay and a 20% coinsurance, as well as preventive dental services like exams, cleanings, and x-rays with no copay and no coinsurance. However, the plan only partially covers dental care, and comprehensive services such as restorative, endodontics, periodontics, prosthodontics, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by UHC Dual Complete SD-Q1 (PPO D-SNP) with no copay, though prior authorization and step therapy may apply. Associated Medicare Part B chemotherapy, radiation, and other Part B drugs carry no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the UHC Dual Complete SD-Q1 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
UHC Dual Complete SD-Q1 (PPO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with prior authorization required. These covered benefits feature no copays and a 20% coinsurance for DME, prosthetics, medical supplies, and diabetic therapeutic shoes.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under UHC Dual Complete SD-Q1 (PPO D-SNP) with prior authorization, featuring no copay for lab services and a copay with 20% coinsurance for diagnostic procedures. Radiological services require no copays, with diagnostic radiology requiring no coinsurance, while therapeutic radiology and outpatient X-rays carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by UHC Dual Complete SD-Q1 (PPO D-SNP) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under UHC Dual Complete SD-Q1 (PPO D-SNP) are covered with no copay and require prior authorization, though some services are covered with a 20% coinsurance instead. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered under the zero-dollar copay and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UHC Dual Complete SD-Q1 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required. While the plan does not require a three-day prior inpatient hospital stay for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UHC Dual Complete SD-Q1 (PPO D-SNP) partially covers other services, providing over-the-counter (OTC) items and chronic-illness meal benefits with no copay and no coinsurance. Acupuncture is not covered, and prior authorization is required for the meal benefit.
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