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UHC Dual Complete UT-V001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete UT-V001 (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-V001 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete UT-V001 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in H0271-039-000. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete UT-V001 (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-V001 (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-V001 (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-V001 (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.
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 $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 $10100.00 (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 $10100.00 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-V001 (PPO D-SNP) plan has a $590.00 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly Part D premium will be $54.70. During the initial coverage phase, you will pay the costs for your drugs until your total drug costs reach $2000.00. Once you reach $2000.00 in out-of-pocket drug costs, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The UHC Dual Complete UT-V001 (PPO D-SNP) plan offers comprehensive coverage with varying costs. The plan has no copay for primary care visits, preventive services like annual exams, and many dental services. However, you can expect copays for inpatient hospital stays, outpatient services, emergency services, specialist visits, hearing aids, and vision services. This plan also includes benefits like ambulance services, hearing and vision care, and dental services. The plan also offers benefits for home health, and medical equipment, along with diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For the first 6 days of an Inpatient Hospital-Acute or Inpatient Hospital Psychiatric stay, there is a $375 copay, and then there is no copay for days 7-90. Additional days for Inpatient Hospital-Acute have no copay, while additional days for Inpatient Hospital Psychiatric are not covered. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $375, observation services with a $375 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, and outpatient blood services with no copay. Prior authorization is required for all of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete UT-V001 (PPO D-SNP) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $120 copay for both ground and air ambulance services; transportation services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the UHC Dual Complete UT-V001 (PPO D-SNP) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0 and $55. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.
Primary Care See details
The UHC Dual Complete UT-V001 (PPO D-SNP) plan covers primary care physician services with no copay, while chiropractic services have a $20 copay. Occupational therapy services have a copay between $0 and $20, and physician specialist services have a copay between $0 and $20. Mental health and psychiatric services have copays that vary based on the type of session, and podiatry services and other health care professional services have a $20 copay. Physical therapy and speech-language pathology services have a copay between $0 and $20, 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, annual physical exams with no copay, and additional preventive services. Additional preventive services include Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. However, the plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, or Counseling Services.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay, while prescription hearing aids have a copay between $199 and $1249, and OTC hearing aids have a copay between $99 and $829. Fitting/evaluation for hearing aids, and prescription hearing aids - inner ear, outer ear, and over the ear, are not covered.
Vision Services See details
The UHC Dual Complete UT-V001 (PPO D-SNP) plan covers vision services, including eye exams with no copay, and eyewear benefits. Eyeglass lenses have a copay from $0 to $153, and frames have no copay, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered under the UHC Dual Complete UT-V001 (PPO D-SNP) plan, with Medicare Dental Services requiring a 20% coinsurance and other services offering a maximum benefit of $1,500 per year. The plan offers no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, maxillofacial prosthetics, and oral and maxillofacial surgery. Restorative services, prosthodontics (removable and fixed), and endodontics have no copay, but coinsurance ranges from 0% to 50%. 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-V001 (PPO D-SNP) plan. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the UHC Dual Complete UT-V001 (PPO D-SNP) plan, with Durable Medical Equipment (DME) subject to 20% coinsurance and Durable Medical Equipment for use outside the home not covered. Prosthetic Devices and Medical Supplies are covered with 20% coinsurance, while Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with no copay, lab services with no copay, and outpatient X-ray services with a $15 copay. Therapeutic Radiological Services have a coinsurance of at most 20%, and Diagnostic Radiological Services have a copay of at most $150.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete UT-V001 (PPO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the UHC Dual Complete UT-V001 (PPO D-SNP) plan, with a $0 copay for days 1-20 and a $203 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
The UHC Dual Complete UT-V001 (PPO D-SNP) plan's other services include Over-the-Counter (OTC) items and a meal benefit with no copay, and 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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