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UHC Dual Complete NY-S001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete NY-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 NY-S001 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete NY-S001 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in New York. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete NY-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 NY-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 NY-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 NY-S001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.30. 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 NY-S001 (PPO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, the monthly premium for the plan is $72.30. Once the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete NY-S001 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1920 copay per admission, while outpatient services, primary care, and other services like home infusion and dialysis have coinsurance between 0% and 20%. Emergency services have a copay of $90, while many preventive, hearing, vision, and dental services have no copay. The plan includes no copay for transportation to health-related locations, hearing exams, prescription hearing aids, eye exams, eyewear, and many dental services. Other notable benefits include coverage for home health services with no copay, plus coverage for medical equipment and diagnostic services with coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, the copay for a Medicare-covered stay is $1920 per admission or stay, and additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital Psychiatric, the copay for a Medicare-covered stay is $1920 per admission or stay. Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a coinsurance of 0% - 20%, observation services have a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services have a coinsurance of 0% - 20%. Individual outpatient substance abuse sessions have a coinsurance of 0% - 20%, while group sessions have a 20% coinsurance. Outpatient blood services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the UHC Dual Complete NY-S001 (PPO D-SNP) plan. This benefit has a $55 copay and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Dual Complete NY-S001 (PPO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services to a plan-approved health-related location has no copay, with up to 36 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 under the UHC Dual Complete NY-S001 (PPO D-SNP) plan. Emergency Services have a $90 copay, Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The UHC Dual Complete NY-S001 (PPO D-SNP) plan covers Primary Care Physician Services, with a coinsurance between 0% and 20%, and covers Chiropractic Services with a 20% coinsurance. The plan also covers Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy, Speech-Language Pathology Services, and Other Health Care Professional services with a coinsurance between 0% and 20%. Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services including fitness benefits, home and bathroom safety devices and modifications. Other preventive services include glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams with a 20% coinsurance, and EKG following a Welcome Visit with a 20% coinsurance.
Hearing Services See details
Hearing Services include coverage for hearing exams, routine hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay and at most 20% coinsurance, and are limited to one per year. Prescription hearing aids have a maximum benefit of $1500 per year with no copay, while OTC hearing aids have no copay and are limited to 2 per year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams and eyewear have no copay, and contact lenses, eyeglass lenses, and eyeglass frames have no copay. Eyeglasses and upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services. 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, implant services, oral and maxillofacial surgery, and orthodontics are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies - Non-Medicare benefit with 20% coinsurance. Diabetic equipment is covered, including Diabetic Supplies with no copay, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests and Therapeutic Radiological Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of at most 20% and a minimum coinsurance of 0%. Lab Services have no copay.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete NY-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 NY-S001 (PPO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan follows Original Medicare for SNF cost-sharing, but additional and non-Medicare-covered SNF days are not covered.
Other Services See details
The UHC Dual Complete NY-S001 (PPO D-SNP) plan's Other Services benefit covers Over-the-Counter (OTC) Items and Meal Benefit with no copay; however, 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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