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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. After the deductible, you will pay costs for drugs, though the specific costs are not listed in this summary. If you qualify for the low-income subsidy, you will pay $72.30 per month for your Part D premium. Once 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, including inpatient hospital stays with a $1590 copay per admission, outpatient services with 0% to 20% coinsurance, and partial hospitalization with a $55 copay. Emergency Services have a $90 copay, while Urgent Services have a copay between $0 and $45. Preventive services, such as an annual physical exam, have no copay. Hearing, vision, and dental services are also covered, with no copay for routine hearing exams, eye exams, and eyewear, as well as oral exams and other preventive dental services. The plan also offers no copay for home health services, acupuncture, and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $1590 per admission or stay, and additional days for Inpatient Hospital-Acute with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and Non-Medicare-covered stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a 0% to 20% coinsurance, observation services with a 20% coinsurance, ambulatory surgical center services with a 0% to 20% coinsurance, and outpatient substance abuse services with a 0% to 20% coinsurance. Also covered are outpatient blood services with a 20% coinsurance, and the plan waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete NY-S001 (PPO D-SNP) plan. The copay for this benefit is $55, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with a limit of 12 one-way trips per year, and no copay.
Emergency Services See details
Emergency Services are covered by the UHC Dual Complete NY-S001 (PPO D-SNP) plan with a $90 copay, while Urgent Services have a copay between $0 and $45. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all 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 of 0% to 20%, and chiropractic services with a 20% coinsurance. Routine chiropractic care has no copay, up to 6 visits per year. The plan also covers occupational therapy services with a 0% to 20% coinsurance, and additional telehealth benefits with no copay.
Preventive Services See details
Preventive Services are covered under UHC Dual Complete NY-S001 (PPO D-SNP), including an annual physical exam with no copay. Other preventive services, like Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas have no copay, while Digital Rectal Exams and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay and a 20% coinsurance, while fitting/evaluation for hearing aids are not covered. Prescription hearing aids have no copay, with a maximum plan benefit of $1500 every year. OTC hearing aids have no copay, with a limit of 2 hearing aids every year.
Vision Services See details
The UHC Dual Complete NY-S001 (PPO D-SNP) plan covers vision services, including routine eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum of $200 per year for both in-network and out-of-network services. Contact lenses, eyeglass lenses, and eyeglass frames are covered with no copay, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services are covered, with 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you will have a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment with 20% coinsurance and Prosthetic Devices with 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay, and 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 NY-S001 (PPO D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not the Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required, and coinsurance applies.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. The plan requires prior authorization and charges the Medicare-defined cost share for tier 1, but does not provide SNF services as a supplemental benefit under Part C.
Other Services See details
Other Services for UHC Dual Complete NY-S001 (PPO D-SNP) includes acupuncture with no copay, up to 12 treatments per year, and over-the-counter items with no copay. Meal benefits are covered with no copay and require prior authorization, while several additional services are not covered.
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