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UHC Dual Complete WA-S5 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete WA-S5 (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 WA-S5 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete WA-S5 (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 Washington. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete WA-S5 (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 WA-S5 (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 WA-S5 (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 WA-S5 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.20. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.20. 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 WA-S5 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After you meet the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your Part D premium will be $26.20. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for your Part D covered drugs.
Additional Benefits
The UHC Dual Complete WA-S5 (PPO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Hospital stays have a copay of $1835 per admission, while outpatient services and ambulance services have coinsurance between 0% and 20%. Emergency and urgent care services have copays, and the plan covers primary care, preventive, hearing, vision, and dental services with no copays for many services. Additional benefits include coverage for home health, medical equipment, and home infusion services, with specific copays or coinsurance. The plan also covers services like acupuncture, over-the-counter items, and a meal benefit, all with no copay. However, certain services like cardiac rehabilitation, private duty nursing, and others are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by the UHC Dual Complete WA-S5 (PPO D-SNP) plan. For Inpatient Hospital-Acute, the copay is $1835.00 per admission or stay and additional days have no copay. Inpatient Hospital Psychiatric has a copay of $1835.00 per admission or stay, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a coinsurance between 0% and 20%, observation services have a 20% coinsurance, and ambulatory surgical center services have a coinsurance between 0% and 20%. Individual sessions for outpatient substance abuse have a coinsurance between 0% and 20%, and group sessions have a 20% coinsurance. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the UHC Dual Complete WA-S5 (PPO D-SNP) plan, but requires prior authorization. The copay for partial hospitalization is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Dual Complete WA-S5 (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Services, are covered by the UHC Dual Complete WA-S5 (PPO D-SNP) plan. Emergency Services have a $110 copay, while Urgent Services have a copay between $0-$45. Worldwide Emergency, Urgent, and Transportation services have no copay.
Primary Care See details
The UHC Dual Complete WA-S5 (PPO D-SNP) plan covers primary care physician services with a coinsurance of 0% to 20%, and also covers chiropractic, occupational therapy, and podiatry services. The plan covers routine chiropractic care with no copay, and occupational therapy services with a coinsurance of 0% to 20%. Podiatry services have a coinsurance of 20% and routine foot care is covered for 12 visits per year.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services with varying copays. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, and Barium Enemas are covered with no copay, while Digital Rectal Exams and EKG following Welcome Visits have a 20% coinsurance. Health Education, In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, 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 Benefits, 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, and Counseling Services are not covered.
Hearing Services See details
Hearing services include coverage for routine hearing exams with no copay and at most 20% coinsurance, and prescription hearing aids with no copay. OTC hearing aids are covered with no copay. 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.
Vision Services See details
Vision services include eye exams, eyewear, and contact lenses. Eye exams and eyewear have no copay, and contact lenses have no copay. Routine eye exams are covered once per year, and eyewear has a combined maximum of $300 per year for both in-network and out-of-network services. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare dental services with 20% coinsurance, along with other dental services, including oral exams, dental x-rays, and cleanings, with no copay. Other services like implants and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by UHC Dual Complete WA-S5 (PPO D-SNP), including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is also covered, with Diabetic Supplies having no copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the UHC Dual Complete WA-S5 (PPO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete WA-S5 (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 not covered by the UHC Dual Complete WA-S5 (PPO D-SNP) plan. Prior authorization is required for these 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, or non-Medicare-covered stays. Prior authorization is required, and you will have a copay for services.
Other Services See details
The UHC Dual Complete WA-S5 (PPO D-SNP) plan covers acupuncture with no copay, up to 12 treatments per year, and also covers over-the-counter items, including nicotine replacement therapy and naloxone, with no copay. The plan also covers a meal benefit with no copay, but requires prior authorization. However, the plan does not cover 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.
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