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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 2026, 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 State of Utah. This plan received an overall rating of 4.5 out of 5 stars in 2026.
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 $17.40. 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 $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) Medicare plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are covered with no copay for one-month or three-month supplies at standard pharmacies and standard mail order. This makes filling basic prescriptions highly affordable for plan members. For Tier 2 generic and Tier 3 preferred brand medications, enrollees pay a 25% coinsurance for both one-month and three-month supplies at standard pharmacies and standard mail order. Tier 4 non-preferred drugs and Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The UHC Dual Complete UT-V001 (PPO D-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, telehealth, and routine preventive services. For specialized medical needs, members can expect low out-of-pocket costs, such as specialist copays up to $35 and no copays for home health services. Emergency care is available with a $130 copay, while inpatient hospital stays require a $395 daily copay for the first several days before transitioning to no copay for subsequent days. This plan also includes valuable supplemental benefits, including routine dental, vision, and hearing exams with no copay, though prescription hearing aids and eyeglass lenses require copayments. Additionally, members benefit from up to 24 one-way transportation trips per year with no copay, alongside no copay for the first 20 days of skilled nursing facility stays. Durable medical equipment and dialysis services are also covered, typically requiring a 20% coinsurance with no copay.
Inpatient Hospital See details
UHC Dual Complete UT-V001 (PPO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute stays require a $395 copay for days 1 to 6 and no copay for subsequent days, while psychiatric stays require a $395 copay for days 1 to 5 and no copay for days 6 to 90. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
UHC Dual Complete UT-V001 (PPO D-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services carry a copay of $0 to $395, while outpatient substance abuse sessions require a copay of $0 to $25, with prior authorization required for most services.
Partial Hospitalization See details
UHC Dual Complete UT-V001 (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 UT-V001 (PPO D-SNP), featuring a $275 copay and no coinsurance for ground and air ambulance services. Transportation benefits are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
UHC Dual Complete UT-V001 (PPO D-SNP) covers emergency services with a $130 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 no copay to $50 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 UT-V001 (PPO D-SNP) provides primary care and telehealth services with no copay and no coinsurance, while specialists and physical, occupational, and speech therapies require copays up to $35 and no coinsurance. Mental health, psychiatric, and podiatry services feature copays ranging from $0 to $35 and no coinsurance, but some chiropractic services are covered while routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by UHC Dual Complete UT-V001 (PPO D-SNP) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. This benefit is partially covered, as specific supplemental services like health education, personal emergency response systems, medical nutrition therapy, and alternative therapies are not covered.
Hearing Services See details
UHC Dual Complete UT-V001 (PPO D-SNP) offers partially covered hearing services, including one routine hearing exam per year with no copay and no coinsurance, and up to two prescription or OTC hearing aids annually with no coinsurance and copays ranging from $199.00 to $1,249.00. Fitting/evaluation for hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
UHC Dual Complete UT-V001 (PPO D-SNP) offers partially covered vision services with no coinsurance, featuring no copay for annual routine eye exams, contact lenses, and eyeglass frames, subject to a $150 combined eyewear limit every two years. Eyeglass lenses are covered with a copay of $0 to $153 and no coinsurance, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
UHC Dual Complete UT-V001 (PPO D-SNP) offers partially covered dental services, featuring Medicare-covered dental care with no copay and a 20% coinsurance. Preventive services like exams, cleanings, x-rays, and fluoride are covered with no copay and no coinsurance, while other diagnostic, restorative, endodontic, periodontic, prosthodontic, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Dual Complete UT-V001 (PPO D-SNP) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
The UHC Dual Complete UT-V001 (PPO D-SNP) plan covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered under UHC Dual Complete UT-V001 (PPO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are covered with no copay, though prior authorization is required for these benefits and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
UHC Dual Complete UT-V001 (PPO D-SNP) covers diagnostic and radiological services, with prior authorization required for all services. Members pay no copay and no coinsurance for lab services and diagnostic radiological services, but will pay a $50 copay for diagnostic tests, a $25 copay for outpatient X-rays, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
UHC Dual Complete UT-V001 (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by UHC Dual Complete UT-V001 (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UHC Dual Complete UT-V001 (PPO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UHC Dual Complete UT-V001 (PPO D-SNP) partially covers other services, providing over-the-counter items and a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture, highly integrated services, and other supplemental services are not covered under this benefit.
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