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UHC Dual Complete IN-D001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete IN-D001 (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 IN-D001 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete IN-D001 (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 Indiana. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete IN-D001 (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 IN-D001 (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 IN-D001 (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 IN-D001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.80. 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 IN-D001 (PPO D-SNP) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). If you have LIS, your monthly premium for Part D is $49.60.
Additional Benefits
The UHC Dual Complete IN-D001 (PPO D-SNP) plan offers a wide range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient hospital services, with a copay for inpatient stays and coinsurance for outpatient services. Emergency and preventive services are covered, often with no copay, along with hearing, vision, and dental services. Additional benefits include coverage for ambulance and transportation, primary care, and home health services, often with no copay. The plan also offers coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities. However, some services such as acupuncture, private duty nursing, and certain rehabilitation services are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, there is a copay of $1580 per admission or stay, and additional days (91-999) have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Inpatient Hospital Psychiatric does not cover additional days or non-Medicare-covered stays.
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. Outpatient hospital services have a coinsurance of 0% to 20%, observation services have a 20% coinsurance, ambulatory surgical center services have a coinsurance between 0% and 20%, individual sessions for outpatient substance abuse have a coinsurance between 0% and 20%, 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 by the UHC Dual Complete IN-D001 (PPO D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and are limited to 24 one-way trips per year via taxi or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.
Primary Care See details
The UHC Dual Complete IN-D001 (PPO D-SNP) plan covers primary care physician services with a 0-20% coinsurance. Chiropractic services are covered with a 20% coinsurance, while routine chiropractic care is not covered. Occupational therapy services have a 0-20% coinsurance. Physician specialist services are covered with a 0-20% coinsurance. Mental health specialty services, including individual sessions (0-20% coinsurance) and group sessions (20% coinsurance), are covered. Podiatry services are covered, with a 20% coinsurance for routine foot care and no copay for Medicare-covered podiatry services. Other health care professional services have a 0-20% coinsurance. Psychiatric services, including individual sessions (0-20% coinsurance) and group sessions (20% coinsurance), are covered. Physical therapy and speech-language pathology services have a 0-20% coinsurance. 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 services with no copay, as well as an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices, are covered with no copay. Other covered services include Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas with no copay, while Digital Rectal Exams and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, and a fitting/evaluation for hearing aid is not covered. Prescription hearing aids are covered with a maximum benefit of $1500 per year and no copay for prescription hearing aids (all types), but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are covered with no copay.
Vision Services See details
The UHC Dual Complete IN-D001 (PPO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams and contact lenses have no copay, while eyeglass lenses and frames have no copay. Eyeglass frames are limited to one per year, and the plan offers a combined maximum of $200 per year for eyewear.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance. Other services like oral exams, x-rays, and cleanings have no copay, while implants and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete IN-D001 (PPO D-SNP) plan. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies also have a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The UHC Dual Complete IN-D001 (PPO D-SNP) plan covers Diagnostic and Radiological Services. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services has 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 IN-D001 (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 Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the UHC Dual Complete IN-D001 (PPO D-SNP) plan, but details on the copay are available elsewhere. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services for the UHC Dual Complete IN-D001 (PPO D-SNP) plan covers Over-the-Counter (OTC) items with no copay, and a meal benefit with no copay, but 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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