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UHC Dual Complete OH-D1 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete OH-D1 (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 OH-D1 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete OH-D1 (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 Ohio. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that UHC Dual Complete OH-D1 (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 OH-D1 (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 OH-D1 (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 OH-D1 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.70. 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 $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:
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Drug Coverage
The UHC Dual Complete OH-D1 (PPO D-SNP) Medicare plan features an annual prescription drug deductible of $615. Beneficiaries will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. This includes no copay for both one-month and three-month supplies of these preferred generic medications. For Tier 2 generic, Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, you will pay a 25% coinsurance. This 25% coinsurance rate applies to standard pharmacy fills as well as standard mail order options for both one-month and three-month supplies where covered.
Additional Benefits
The UHC Dual Complete OH-D1 (PPO D-SNP) plan offers comprehensive medical coverage with no copays for primary care, outpatient hospital services, and skilled nursing facility stays. While inpatient hospital stays require a $2,035 copay per stay, emergency services feature a $115 copay that is waived if you are admitted. Most other outpatient care, specialist visits, and durable medical equipment require no copay and a coinsurance of up to 20%. Beneficiaries also enjoy valuable supplemental benefits, including routine dental, vision, and hearing care with no copays and mostly no coinsurance. The plan covers routine eye exams with a $150 eyewear allowance, up to 24 one-way transportation trips per year to approved locations, and over-the-counter items with no copay or coinsurance. Additionally, many preventive services, home health visits, and telehealth consultations are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
UHC Dual Complete OH-D1 (PPO D-SNP) partially covers inpatient hospital services with a $2,035 copay per stay and no coinsurance for both acute and psychiatric stays, though prior authorization is required. Non-Medicare-covered stays, upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient services covered by UHC Dual Complete OH-D1 (PPO D-SNP) feature no copays, with coinsurance ranging from no coinsurance up to 20% for outpatient hospital, ambulatory surgical center, and substance abuse services. Observation and outpatient blood services also have no copay and a 20% coinsurance, with prior authorization required for most of these outpatient benefits.
Partial Hospitalization See details
Partial hospitalization is covered by UHC Dual Complete OH-D1 (PPO D-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
UHC Dual Complete OH-D1 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any other health-related locations is not covered.
Emergency Services See details
UHC Dual Complete OH-D1 (PPO D-SNP) covers emergency services with a $115 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 $0 to $40 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Primary care benefits through UHC Dual Complete OH-D1 (PPO D-SNP) are covered with no copays and coinsurance ranging from 0% to 20% for most services, including primary care, specialist visits, and mental health services. Chiropractic services are not covered, but telehealth and opioid treatment program services are fully covered with no copay and no coinsurance.
Preventive Services See details
UHC Dual Complete OH-D1 (PPO D-SNP) covers preventive services with no copay and no coinsurance for most services, including annual physicals, kidney disease education, and fitness benefits. Some services, like digital rectal exams and post-welcome visit EKGs, require a 20% coinsurance with no copay. This benefit is partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, additional smoking cessation, disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
UHC Dual Complete OH-D1 (PPO D-SNP) offers partially covered hearing services, featuring one annual routine hearing exam with no copay and 20% coinsurance, though fitting and evaluation exams are not covered. Prescription and OTC hearing aids are covered with no copay or coinsurance (limited to two every two years), but inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by UHC Dual Complete OH-D1 (PPO D-SNP) with no deductibles, no copays, and no coinsurance. Covered benefits include one routine eye exam and either contact lenses (up to $150) or one pair of eyeglasses (lenses and frames) every year, while other eye exam services, eyeglass lenses, and eyeglass frames are not covered.
Dental Services See details
UHC Dual Complete OH-D1 (PPO D-SNP) dental services are partially covered, offering preventive and most comprehensive care with no copay and no coinsurance, though fixed prosthodontics are not covered. Medicare-covered dental services require a 20% coinsurance and no copay, and prior authorization is required for several comprehensive services.
Home Infusion bundled Services See details
UHC Dual Complete OH-D1 (PPO D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by UHC Dual Complete OH-D1 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
UHC Dual Complete OH-D1 (PPO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, subject to manufacturer limits, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
UHC Dual Complete OH-D1 (PPO D-SNP) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and diagnostic radiological services with no copay or coinsurance. Diagnostic procedures and tests require a copay and 20% coinsurance, while therapeutic radiological and outpatient X-ray services have no copay but require 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the UHC Dual Complete OH-D1 (PPO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by UHC Dual Complete OH-D1 (PPO D-SNP) with no copay and require prior authorization, though only some services are covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete OH-D1 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no copayment and no coinsurance, though prior authorization is required. The plan allows for admission without a prior 3-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UHC Dual Complete OH-D1 (PPO D-SNP) partially covers other services, offering over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture is not covered by this plan, and prior authorization is required for the meal benefit.
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