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UHC Dual Complete UT-S001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete UT-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 UT-S001 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete UT-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 Utah. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete UT-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 UT-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 UT-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 UT-S001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $54.70. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.70. 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 UT-S001 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for your drugs according to the plan's formulary until your total drug costs reach $2000. If you qualify for the low-income subsidy, your monthly Part D premium will be $54.70. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered drugs.
Additional Benefits
The UHC Dual Complete UT-S001 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing options. Inpatient hospital stays require a $1,965 copay per admission, while outpatient services and primary care have coinsurance between 0% and 20%. Emergency services have a $110 copay, and transportation to health-related locations is covered with no copay. Preventive, hearing, vision, and dental services include benefits like routine exams and eyewear with no copays, and some services like home health and home infusion services are covered. The plan also covers a variety of other services, such as ambulance and transportation services, and medical equipment. However, certain services like cardiac rehabilitation and some home health services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a copay of $1,965 per admission or stay. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered under this plan. Outpatient hospital services have a coinsurance of 0% - 20%, observation services have a 20% coinsurance, individual sessions for outpatient substance abuse have a 0% - 20% coinsurance, group sessions for outpatient substance abuse have a 20% coinsurance, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, with a 20% coinsurance. Transportation Services to plan-approved health-related locations are covered with no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the UHC Dual Complete UT-S001 (PPO D-SNP) plan. Emergency Services has a $110 copay, while Urgently Needed Services has a copay of $0-$45; both have no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, have no copay and no coinsurance.
Primary Care See details
The UHC Dual Complete UT-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. The plan also covers mental health specialty services with 0% to 20% coinsurance for individual sessions and 20% coinsurance for group sessions, podiatry services with 20% coinsurance and no copay, other health care professional services with 0% to 20% coinsurance, psychiatric services with 0% to 20% coinsurance for individual sessions and 20% coinsurance for group sessions, physical therapy and speech-language pathology services with 0% to 20% coinsurance, additional telehealth benefits with no copay, and opioid treatment program services with no copay.
Preventive Services See details
The UHC Dual Complete UT-S001 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Home and Bathroom Safety Devices and Modifications with no copay. Other preventive services may have a copay or 20% coinsurance. Some services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The UHC Dual Complete UT-S001 (PPO D-SNP) plan covers hearing exams with at most 20% coinsurance, and Routine Hearing Exams with no copay. The plan also covers prescription hearing aids with no copay for all types, up to a maximum of $1500 every year. 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. OTC hearing aids have no copay.
Vision Services See details
The UHC Dual Complete UT-S001 (PPO D-SNP) plan covers vision services, including routine eye exams with no copay and eyewear with a combined maximum of $300 per year. Contact lenses, eyeglass lenses, and eyeglass frames are covered with no copay, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with Medicare Dental Services subject to a 20% coinsurance. Other services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services, all with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery are covered with no copay. However, Implant Services and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete UT-S001 (PPO D-SNP) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, and Diabetic Equipment, is covered. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Diabetic Supplies have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, have a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a coinsurance of at most 20% with a minimum of 0%, while Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20% with a minimum of 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete UT-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 UT-S001 (PPO D-SNP) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered stays. Prior authorization is required, and the plan charges the Medicare-defined cost share for tier 1.
Other Services See details
The UHC Dual Complete UT-S001 (PPO D-SNP) plan does not cover 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. Over-the-counter items have no copay, and meal benefits have no copay.
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