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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 2026, 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 4.5 out of 5 stars in 2026.
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 $52.80. 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 $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 NY-S001 (PPO D-SNP) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are covered with no copay for standard pharmacy fills and standard mail orders. This allows members to access essential preferred generic medications without any out-of-pocket costs. For all other drug tiers, including generic, preferred brand, non-preferred, and specialty drugs, members are responsible for a 25% coinsurance. This 25% cost sharing applies to standard pharmacy fills and standard mail order options across Tiers 2 through 5. These structured tiers help members clearly understand and predict their prescription medication expenses throughout the year.
Additional Benefits
The UHC Dual Complete NY-S001 (PPO D-SNP) offers robust medical coverage, featuring inpatient hospital stays with a $2,230 copay and outpatient services with no copays and up to 20% coinsurance. You can access primary care, specialist, and telehealth visits with no copays, while home health and skilled nursing facility stays are also covered with no copays or coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within 24 hours. For everyday wellness, the plan covers preventive and comprehensive dental care, routine vision exams, and annual physicals with no copays or coinsurance. Vision benefits include a $200 annual allowance for frames or lenses, and hearing aid coverage is provided up to $1,500 every two years with no copay. Additionally, members receive over-the-counter items and fitness benefits at no cost, making essential health services highly accessible.
Inpatient Hospital See details
UHC Dual Complete NY-S001 (PPO D-SNP) covers inpatient acute hospital stays with a $2,230 copay per stay, no coinsurance, and unlimited additional days with no copay, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are covered with a $2,080 copay per stay and no coinsurance, but additional days and non-Medicare-covered stays are excluded, and prior authorization is required for both services.
Outpatient Services See details
Outpatient services are covered by UHC Dual Complete NY-S001 (PPO D-SNP) with no copays for all outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Coinsurance ranges from 0% to 20% depending on the specific service, and prior authorization is required for most treatments.
Partial Hospitalization See details
UHC Dual Complete NY-S001 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
UHC Dual Complete NY-S001 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Some transportation services are covered under the plan, but transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
UHC Dual Complete NY-S001 (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 of $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
UHC Dual Complete NY-S001 (PPO D-SNP) covers primary care, specialist, and therapy services with no copays and coinsurance ranging from no coinsurance up to 20%. Telehealth and opioid treatment programs are fully covered with no copays and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
UHC Dual Complete NY-S001 (PPO D-SNP) partially covers preventive services, providing annual physicals, kidney disease education, and fitness benefits with no copay and no coinsurance, though digital rectal exams and follow-up EKGs carry a 20% coinsurance. Excluded services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, additional smoking cessation, enhanced disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
Hearing Services are partially covered by UHC Dual Complete NY-S001 (PPO D-SNP), featuring one annual routine hearing exam with no copay and a 20% coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids are covered up to a $1,500 limit every two years with no copay and no coinsurance, but inner ear, outer ear, and over the ear types are not covered. Up to two OTC hearing aids are also covered every two years with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by UHC Dual Complete NY-S001 (PPO D-SNP) with no copay and no coinsurance, featuring one routine eye exam and up to a $200 annual allowance for contact lenses, eyeglass lenses, and frames. Other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are covered by UHC Dual Complete NY-S001 (PPO D-SNP) with no copay and a 20% coinsurance for Medicare-covered dental care. Preventive and comprehensive dental services, including cleanings, exams, and orthodontic treatments, are covered with no copay and no coinsurance, though prior authorization is required for certain services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Dual Complete NY-S001 (PPO D-SNP) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the UHC Dual Complete NY-S001 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
UHC Dual Complete NY-S001 (PPO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete NY-S001 (PPO D-SNP) with prior authorization required. Diagnostic procedures and tests require a copay and 20% minimum coinsurance, while lab services have no copay. Diagnostic radiological services feature no copay and no coinsurance, whereas therapeutic radiological and outpatient X-ray services require a 20% minimum coinsurance and no copay.
Home Health Services See details
UHC Dual Complete NY-S001 (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 under UHC Dual Complete NY-S001 (PPO D-SNP) are covered with no copay and require prior authorization, although only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete NY-S001 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. This plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by UHC Dual Complete NY-S001 (PPO D-SNP), offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, though prior authorization is required for meals. Acupuncture, highly integrated services for dual eligible SNPs, and other additional services are not covered under this plan.
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