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UHC Dual Complete OH-S001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete OH-S001 (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-S001 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete OH-S001 (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 out of 5 stars in 2025.
It's important to know that UHC Dual Complete OH-S001 (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-S001 (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-S001 (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-S001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.30. 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 OH-S001 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs depending on the tier and pharmacy type. Once your total drug costs reach $2000, you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D is $39.30. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The UHC Dual Complete OH-S001 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1710 copay, while emergency services have a $110 copay. Many services, including primary care, preventive services, hearing exams, vision services, and dental services, have no copay or coinsurance, offering significant cost savings. This plan includes coverage for outpatient services, ambulance services, and home health services, with a mix of copays and coinsurance. Additional benefits include coverage for hearing aids, dental services, and medical equipment. Some services, like cardiac rehabilitation and additional hours of care, are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, there is a $1710 copay per admission or stay, and additional days have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital-Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a coinsurance of 0% to 20%, Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a coinsurance between 0% and 20%, Outpatient Substance Abuse Services with a coinsurance between 0% and 20% for individual sessions and a 20% coinsurance for group sessions, and Outpatient Blood Services with a 20% coinsurance. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete OH-S001 (PPO D-SNP) plan and requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, as well as transportation to plan-approved health-related locations. Ground and air ambulance services have a 20% coinsurance, and transportation services have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UHC Dual Complete OH-S001 (PPO D-SNP) plan. Emergency Services has a $110 copay, and Urgently Needed Services have a copay between $0 and $45; all other services have no copay.
Primary Care See details
Primary care physician services, occupational therapy, physician specialist services, mental health specialty services, psychiatric services, physical therapy, speech-language pathology, additional telehealth, and opioid treatment program services are covered by this plan, with coinsurance between 0% and 20% for some services. Chiropractic services are covered with 20% coinsurance, and routine foot care has 20% coinsurance. Additional telehealth benefits have no copay.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services. Additional preventive services have varying copays, and specific services like Health Education, In-Home Safety Assessment, and others 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 a maximum benefit of $2200 per year and no copay. Fitting/evaluation for hearing aids, and prescription hearing aids (inner ear, outer ear, and over the ear) are not covered. OTC hearing aids are covered with no copay.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear benefits include contact lenses, eyeglass lenses, and eyeglass frames, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Dual Complete OH-S001 (PPO D-SNP) plan covers dental services with a 20% coinsurance for Medicare dental services. Other dental services have a maximum benefit of $2,000 per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no copay. Orthodontic services and implant services 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 0-20%. For Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs, coinsurance is between 0-20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization, and the coinsurance is 20%.
Medical Equipment See details
Medical Equipment is covered by the UHC Dual Complete OH-S001 (PPO D-SNP) plan. Durable Medical Equipment (DME), Prosthetic Devices, and Medicare-covered Medical Supplies have a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the UHC Dual Complete OH-S001 (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 OH-S001 (PPO D-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the UHC Dual Complete OH-S001 (PPO D-SNP) plan. Prior authorization is required for services, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the cost sharing details are not provided. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The UHC Dual Complete OH-S001 (PPO D-SNP) plan covers Over-the-Counter (OTC) items and Meal Benefits. OTC items have no copay, while meal benefits also have no copay and require prior authorization. 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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