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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 2026, 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 4.5 out of 5 stars in 2026.
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 $9.40. 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 $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 WA-S5 (PPO D-SNP)
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Drug Coverage
The UHC Dual Complete WA-S5 (PPO D-SNP) Medicare plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for 1-month and 3-month supplies at standard pharmacies, as well as 3-month supplies through standard mail order. This cost structure ensures affordable access to everyday generic medications. For Tier 2 generic, Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, members are responsible for a 25% coinsurance. This 25% coinsurance applies to standard pharmacy fills and standard mail order options, depending on the tier and supply duration. These clear pricing tiers help you understand your out-of-pocket prescription costs.
Additional Benefits
The UHC Dual Complete WA-S5 (PPO D-SNP) offers comprehensive medical coverage, featuring no copay for primary care, specialist visits, and outpatient services, though coinsurance up to 20% may apply. Inpatient hospital stays require a $2,050 copay per stay with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Additionally, many essential services like home health care and skilled nursing facility stays are covered with no copay and no coinsurance. For routine and supplemental care, this plan provides dental coverage up to a $2,500 annual limit and vision services with a $200 annual allowance, both with no copay and no coinsurance. Members also benefit from up to 24 free one-way transportation trips per year and a $2,200 hearing aid allowance every two years with no copay or coinsurance. Other daily health needs, including diabetic supplies and over-the-counter items, are similarly covered with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by UHC Dual Complete WA-S5 (PPO D-SNP) with a $2,050 copay per stay and no coinsurance for both acute and psychiatric care, requiring prior authorization. Unlimited additional acute days are covered with no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under UHC Dual Complete WA-S5 (PPO D-SNP) are covered with no copay, though coinsurance ranging from no coinsurance up to 20% may apply depending on the service. This coverage includes outpatient hospital, ambulatory surgical center, substance abuse, and blood services, most of which require prior authorization.
Partial Hospitalization See details
UHC Dual Complete WA-S5 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UHC Dual Complete WA-S5 (PPO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
UHC Dual Complete WA-S5 (PPO D-SNP) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services feature a copay of $0 to $40 and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
UHC Dual Complete WA-S5 (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and coinsurance ranging from 0% to 20%. Chiropractic services are partially covered, providing routine care with no copay and 20% coinsurance while excluding other chiropractic services, while telehealth and opioid treatments feature no copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by UHC Dual Complete WA-S5 (PPO D-SNP), featuring an annual physical, fitness benefits, and kidney disease education with no copay and no coinsurance. While several supplemental services like health education, in-home safety assessments, and personal emergency response systems are not covered, other services such as digital rectal exams and EKGs require a 20% coinsurance and no copay.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete WA-S5 (PPO D-SNP), offering one routine hearing exam per year with a 20% coinsurance and no copay, while fitting and evaluation exams are not covered. Prescription and OTC hearing aids are covered with no copay and no coinsurance up to a $2,200 maximum limit every two years, though inner ear, outer ear, and over-the-ear prescription types are not covered.
Vision Services See details
UHC Dual Complete WA-S5 (PPO D-SNP) partially covers vision services with no copay, no coinsurance, and no deductible, offering one routine eye exam and a $200 annual limit for contact lenses, eyeglass lenses, and frames. Other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services through UHC Dual Complete WA-S5 (PPO D-SNP) are partially covered up to a $2,500 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require no copay and a 20% coinsurance, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
UHC Dual Complete WA-S5 (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a 0% to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by UHC Dual Complete WA-S5 (PPO D-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by UHC Dual Complete WA-S5 (PPO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
UHC Dual Complete WA-S5 (PPO D-SNP) covers diagnostic and radiological services with prior authorization required. Lab services feature no copay and diagnostic radiological services have no coinsurance, while diagnostic procedures, therapeutic radiology, and outpatient x-rays require a 20% coinsurance.
Home Health Services See details
UHC Dual Complete WA-S5 (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 covered by UHC Dual Complete WA-S5 (PPO D-SNP) with no copay and 20% coinsurance, requiring prior authorization. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease are not covered.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete WA-S5 (PPO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. The plan allows admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by UHC Dual Complete WA-S5 (PPO D-SNP) with no copay and no coinsurance for covered benefits, which include acupuncture up to 12 treatments annually, over-the-counter items, and meal benefits for chronic illness requiring prior authorization. Highly integrated services and other miscellaneous services are not covered.
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