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UHC Dual Complete WV-V001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete WV-V001 (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 WV-V001 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete WV-V001 (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 West Virgina. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete WV-V001 (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 WV-V001 (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 WV-V001 (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 WV-V001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $48.40. 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 $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 $10100.00 (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 $10100.00 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 WV-V001 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After meeting your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly Part D premium is $48.40. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete WV-V001 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have a mix of copays, including no copay for some services. Emergency services have a copay, and primary care visits are covered with no copay. Preventive services, routine hearing exams, and vision services like eye exams and frames are covered with no copay. Dental services have a coinsurance, while services like home health and skilled nursing facilities also have copays or coinsurance. The plan also covers medical equipment and home infusion with coinsurance, and offers OTC items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, with a copay of $265 for days 1-6 and no copay for days 7-90; additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$265, Observation Services with a $265 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay of $0-$25 for individual sessions and a $15 copay for group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete WV-V001 (PPO D-SNP) plan with a $55 copay. Prior authorization is required for this benefit.
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 $200 copay and no coinsurance. 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 WV-V001 (PPO D-SNP) plan. Emergency services have a $125 copay, urgently needed services have a copay between $0 and $55, and worldwide emergency services have no copay for worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation.
Primary Care See details
The UHC Dual Complete WV-V001 (PPO D-SNP) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a copay between $0 and $20, while specialist services have a copay between $0 and $20. Mental health specialty services, including individual and group sessions, have copays of $0-$25 and $15, respectively. Podiatry services, other healthcare professional, and psychiatric services have copays ranging from $20 to $20, $0 to $20, and $0-$25 (individual sessions) and $15 (group sessions), respectively. Physical therapy and speech-language pathology services have a copay between $0 and $20. Additional telehealth and opioid treatment program services have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional services such as fitness benefits and home and bathroom safety devices and modifications are covered with no copay. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are covered with no copay. However, 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 routine hearing exams with no copay and are limited to one per year, while fitting/evaluation for hearing aids is not covered. Prescription hearing aids are covered with a copay between $199 and $1249 for up to two hearing aids per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are covered with a copay between $99 and $829 for two hearing aids per year.
Vision Services See details
The UHC Dual Complete WV-V001 (PPO D-SNP) plan covers routine eye exams and eyewear. Routine eye exams and contact lenses have no copay, while eyeglass lenses have a copay of $0-$153, and eyeglass frames have no copay. Eyeglass frames are limited to one pair every two years, and contact lenses are unlimited. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a coinsurance of 20% for Medicare Dental Services. Other dental services include 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), maxillofacial prosthetics, oral and maxillofacial surgery; these have a $0 copay. Prosthodontics (fixed) and prosthodontics (removable) have a coinsurance ranging from 0% to 50%. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the UHC Dual Complete WV-V001 (PPO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay with 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete WV-V001 (PPO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the UHC Dual Complete WV-V001 (PPO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while 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
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay for diagnostic procedures/tests of $25, lab services with no copay, and outpatient X-ray services with a $15 copay. Diagnostic radiological services have a copay up to $205, and therapeutic radiological services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete WV-V001 (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 covered, but the plan does not cover the sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Dual Complete WV-V001 (PPO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The UHC Dual Complete WV-V001 (PPO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits. OTC items have no copay, and the Meal Benefit requires prior authorization and has no copay. 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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