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UHC Complete Care NM-11 (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Complete Care NM-11 (PPO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Complete Care NM-11 (PPO C-SNP) in 2026, please refer to our full plan details page.
UHC Complete Care NM-11 (PPO C-SNP) is a PPO C-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in New Mexico. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that UHC Complete Care NM-11 (PPO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
UHC Complete Care NM-11 (PPO C-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 Complete Care NM-11 (PPO C-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 Complete Care NM-11 (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $520.00 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 Complete Care NM-11 (PPO C-SNP) plan features an annual drug deductible of $520. For Tier 1 preferred generic drugs, you will enjoy no copay for standard pharmacy options and mail orders. Tier 2 generic drugs require an $8 copay for a 1-month supply at standard pharmacies, but you can secure a 3-month supply with no copay using preferred mail order. Higher-tier medications under this plan transition to coinsurance costs instead of flat copays. Tier 3 preferred brand drugs require a 19% coinsurance, while Tier 4 non-preferred drugs carry a 40% coinsurance. Specialty Tier 5 medications require a 27% coinsurance for a 1-month supply across standard pharmacies and mail order services.
Additional Benefits
The UHC Complete Care NM-11 (PPO C-SNP) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, telehealth, annual physicals, and home health services. For inpatient hospital stays, members pay no coinsurance and a $550 copay per day for the first few days, with no copay for the remaining days. Emergency room visits require a $130 copay, which is waived if admitted, while specialist visits feature copays ranging from $0 to $35. Routine dental cleanings, annual eye exams, and yearly hearing tests are available with no copay or coinsurance, though comprehensive dental services are not covered. Diagnostic labs and diabetic supplies also feature no copay, while durable medical equipment and dialysis services require a 20% coinsurance. Additionally, members can benefit from a $300 eyewear allowance every two years and covered over-the-counter items with no copay.
Inpatient Hospital See details
UHC Complete Care NM-11 (PPO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $550 copay for days 1 through 5 of acute stays and days 1 through 4 of psychiatric stays, with no copay for remaining days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by UHC Complete Care NM-11 (PPO C-SNP) with no coinsurance and prior authorization required for most treatments. Patients will pay no copay for ambulatory surgical center and blood services, while copays range from $0 to $550 for outpatient hospital and observation services, and $0 to $25 for outpatient substance abuse sessions.
Partial Hospitalization See details
UHC Complete Care NM-11 (PPO C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services under UHC Complete Care NM-11 (PPO C-SNP) are partially covered, featuring a $155 copay and no coinsurance for ground and air ambulance services, which require prior authorization. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services under UHC Complete Care NM-11 (PPO C-SNP) are covered with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a copay of $0 to $50 with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Primary care physician services and telehealth are covered by UHC Complete Care NM-11 (PPO C-SNP) with no copay and no coinsurance. Other covered outpatient services feature no coinsurance but require copays, such as specialist visits ($0 to $35), physical therapy ($20), and mental health sessions ($0 to $25), though routine chiropractic care is not covered.
Preventive Services See details
Preventive services are covered by UHC Complete Care NM-11 (PPO C-SNP) with no copay and no coinsurance, including annual physicals, kidney disease education, and diabetes training. Additional preventive benefits are partially covered; while fitness benefits and home safety devices have no copay or coinsurance, other services like health education, personal emergency response systems, and nutritional counseling are not covered.
Hearing Services See details
Hearing services are partially covered by UHC Complete Care NM-11 (PPO C-SNP), featuring one routine hearing exam per year with no copay, no coinsurance, and no deductible, though fitting and evaluation exams are not covered. Prescription and OTC hearing aids are covered with no coinsurance and copays ranging from $199.00 to $1,249.00 for prescription models and $199.00 to $829.00 for OTC models, though inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by UHC Complete Care NM-11 (PPO C-SNP) with no deductible and no coinsurance, providing one routine eye exam annually with no copay, though other eye exam services are not covered. Eyewear is also partially covered up to a $300 limit every two years with no coinsurance, featuring no copay for contact lenses and frames, and a $0 to $153 copay for lenses, while upgrades and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by UHC Complete Care NM-11 (PPO C-SNP), offering preventive care like exams, cleanings, fluoride, and X-rays with no copay and no coinsurance. Medicare-covered dental services are available with no copay and a 20% coinsurance, but comprehensive services such as restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
UHC Complete Care NM-11 (PPO C-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy may be required. Associated Medicare Part B drugs, such as chemotherapy and radiation, have no coinsurance up to 20% coinsurance, while Part B insulin drugs have a $35 copay and up to 20% coinsurance.
Dialysis Services See details
UHC Complete Care NM-11 (PPO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by UHC Complete Care NM-11 (PPO C-SNP), featuring no copay and 20% coinsurance for durable medical equipment (DME) and prosthetics. Diabetic equipment and supplies from specified manufacturers are covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Complete Care NM-11 (PPO C-SNP) with prior authorization required. Lab services and diagnostic radiology have no copay, while diagnostic tests require a $50 copay with no coinsurance, outpatient X-rays require a $25 copay, and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home health services are covered under the UHC Complete Care NM-11 (PPO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the UHC Complete Care NM-11 (PPO C-SNP) plan. This includes no coverage for intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by UHC Complete Care NM-11 (PPO C-SNP) with no coinsurance, requiring no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UHC Complete Care NM-11 (PPO C-SNP) partially covers other services, offering over-the-counter (OTC) items and a chronic illness meal benefit 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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