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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 2026, 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 Virginia. This plan received an overall rating of 4.5 out of 5 stars in 2026.
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 $32.70. 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 $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) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies for 1-month or 3-month supplies, as well as for 3-month standard mail-order services. For Tier 2 generic and Tier 3 preferred brand drugs, you are responsible for a 25% coinsurance for both 1-month and 3-month supplies. Tier 4 non-preferred drugs and Tier 5 specialty drugs also require a 25% coinsurance for 1-month supplies filled at standard retail pharmacies or standard mail order.
Additional Benefits
The UHC Dual Complete WV-V001 (PPO D-SNP) offers robust coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, telehealth, home health, and preventive services. For emergency care, there is a $130 copay that is waived if you are admitted, while inpatient acute hospital stays require a $395 daily copay for the first six days and no copay thereafter. Specialist visits require up to a $40 copay, and skilled nursing facility stays are covered with no copay for the first 20 days. This plan also includes essential ancillary benefits, providing routine eye exams and preventive dental care with no copay and no coinsurance. Hearing services feature no copay for annual routine exams, though prescription hearing aids require a copay ranging from $199 to $1,249. Additionally, many diagnostic lab tests and chronic illness meals require no copay, while durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
UHC Dual Complete WV-V001 (PPO D-SNP) inpatient hospital benefits are partially covered with no coinsurance, but require prior authorization. Acute stays require a $395 copay for days 1-6 and no copay for days 7 and beyond, while psychiatric stays require a $395 copay for days 1-5 and no copay for days 6-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by UHC Dual Complete WV-V001 (PPO D-SNP) with no coinsurance, though prior authorization is required for most services. Copays range from $0 to $395 for outpatient hospital and observation services, $0 to $25 for substance abuse sessions, and no copay for ambulatory surgical center and blood services.
Partial Hospitalization See details
Partial hospitalization is covered by UHC Dual Complete WV-V001 (PPO D-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
UHC Dual Complete WV-V001 (PPO D-SNP) covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. While some transportation services are covered, transportation to plan-approved health-related locations or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by UHC Dual Complete WV-V001 (PPO D-SNP) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay of $0 to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Primary care physician and telehealth services are covered under UHC Dual Complete WV-V001 (PPO D-SNP) with no copay and no coinsurance, while chiropractic services are not covered. Other covered benefits feature no coinsurance, with copays of $0 to $40 for specialists, $20 for physical and occupational therapy, and up to $25 for individual mental health sessions.
Preventive Services See details
Preventive services are partially covered by UHC Dual Complete WV-V001 (PPO D-SNP) with no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and caregiver support. However, specific sub-services such as health education, nutritional benefits, personal emergency response systems, and alternative therapies are not covered.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete WV-V001 (PPO D-SNP), offering one routine hearing exam annually with no copay and no coinsurance, though hearing aid fittings and evaluations are not covered. Prescription hearing aids are covered with a copay of $199.00 to $1,249.00 and no coinsurance, but inner ear, outer ear, and over the ear types are not covered. OTC hearing aids are covered with a copay of $199.00 to $829.00 and no coinsurance, with a limit of two hearing aids per year.
Vision Services See details
Vision services are partially covered by UHC Dual Complete WV-V001 (PPO D-SNP) with no deductibles and no coinsurance. Routine eye exams, contact lenses, and eyeglass frames are covered with no copay, and eyeglass lenses are covered with a $0 to $153 copay up to a $150 limit every two years, while other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by UHC Dual Complete WV-V001 (PPO D-SNP), offering preventive care with no copay and no coinsurance up to a $1,500 annual limit. Medicare-covered dental services require no copay and a 20% coinsurance, and covered comprehensive services require no copay and a 50% coinsurance, though implant services and orthodontics are not covered.
Home Infusion bundled Services See details
UHC Dual Complete WV-V001 (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete WV-V001 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
UHC Dual Complete WV-V001 (PPO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic shoes and inserts require 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete WV-V001 (PPO D-SNP) with prior authorization required. Diagnostic tests require a $50 copay and no coinsurance, lab services and diagnostic radiology have no copay or coinsurance, while outpatient x-rays require a $25 copay and therapeutic radiology has a 20% coinsurance.
Home Health Services See details
UHC Dual Complete WV-V001 (PPO D-SNP) covers home health services 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 WV-V001 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete WV-V001 (PPO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by UHC Dual Complete WV-V001 (PPO D-SNP), featuring over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required for the meal benefit.
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