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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 2025, 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 out of 5 stars in 2025.
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 $340.00 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 has a $340 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, the copay for a standard generic drug is $47.00, while the coinsurance for a non-preferred drug is 29%. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The UHC Complete Care NM-11 (PPO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including primary care and preventive services, often have no copay. Emergency services, vision, and dental services are also covered, with some services requiring a copay or coinsurance. This plan also covers hearing exams, with copays for hearing aids, and offers coverage for home health services, medical equipment, and diagnostic services. Other benefits include ambulance services with a copay and skilled nursing facility stays with a copay after the initial 20 days. However, some services like acupuncture and private duty nursing are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you pay a $300 copay for days 1-6, and no copay for days 7-90, while additional days have no copay; for Inpatient Hospital Psychiatric, you pay a $300 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and 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 and outpatient blood services, are covered with no copay. Observation services have a $300 copay per day, and Ambulatory Surgical Center (ASC) Services have no copay. Individual outpatient substance abuse sessions have a copay between $0 and $25, and group sessions have a $15 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the UHC Complete Care NM-11 (PPO C-SNP) plan. Both Medicare-covered ground and air ambulance services have a $275 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency services, urgently needed services, and worldwide emergency services are covered under the UHC Complete Care NM-11 (PPO C-SNP) plan. Emergency services have a $125 copay and no coinsurance, while urgently needed services have a copay between $0 and $55, with no coinsurance. Worldwide emergency services have no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Under the UHC Complete Care NM-11 (PPO C-SNP) plan, primary care physician services and additional telehealth benefits have no copay, and chiropractic services have a $20 copay. Physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, and opioid treatment program services have varying copays. Physical therapy and speech-language pathology services have a copay between $0 and $20.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services, including fitness benefits, with no copay. Other services like health education, in-home safety assessment, and others are not covered.
Hearing Services See details
Hearing exams are covered with no copay, including routine hearing exams. Prescription hearing aids are covered with a copay between $199 and $1249 depending on the type of hearing aid. OTC hearing aids are covered with a copay between $99 and $829. Fitting/evaluation for hearing aids, 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 and eyewear. Eye exams have no copay, and eyewear has a combined maximum benefit of $250 every two years; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services with the UHC Complete Care NM-11 (PPO C-SNP) plan include coverage for Medicare Dental Services with 20% coinsurance, and Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services with no copay. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. The coinsurance for this benefit is 20%.
Medical Equipment See details
Medical Equipment is covered under the UHC Complete Care NM-11 (PPO C-SNP) plan, with Durable Medical Equipment (DME) requiring 20% coinsurance and Prosthetic Devices also requiring 20% coinsurance. Medical Supplies have a 20% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a $50 copay, and lab services with no copay. Radiological Services are covered with a copay of up to $215 for diagnostic services and a coinsurance of at least 20% for therapeutic services, while outpatient X-rays have a $25 copay.
Home Health Services See details
Home Health Services are covered by the UHC Complete Care NM-11 (PPO C-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 covered by the UHC Complete Care NM-11 (PPO C-SNP) plan, but services such as Medicare-covered Intensive Cardiac Rehabilitation, Medicare-covered Pulmonary Rehabilitation, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD), and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Complete Care NM-11 (PPO C-SNP) plan, with prior authorization required. There is no copay for days 1-20, but there is a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The UHC Complete Care NM-11 (PPO C-SNP) plan does not cover 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. Over-the-counter (OTC) items and meal benefits are covered with no copay, and prior authorization is required for meal benefits.
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