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UHC Dual Complete WA-S1 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete WA-S1 (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 WA-S1 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete WA-S1 (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 Washington. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that UHC Dual Complete WA-S1 (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 WA-S1 (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 WA-S1 (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 WA-S1 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.50. 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:
Sign up for UHC Dual Complete WA-S1 (PPO D-SNP)
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Drug Coverage
The UHC Dual Complete WA-S1 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies, or for a 3-month supply through standard mail order. This ensures that many common, essential medications remain highly affordable. For Tier 2 generic and Tier 3 preferred brand drugs, members pay a 25% coinsurance for 1-month and 3-month supplies at standard pharmacies and standard mail order. Tier 4 non-preferred drugs and Tier 5 specialty drugs also require a 25% coinsurance for a 1-month supply. This plan provides a clear cost-sharing structure to help you manage your healthcare budget.
Additional Benefits
The UHC Dual Complete WA-S1 (PPO D-SNP) plan offers robust medical coverage with many essential services available with no copay. While inpatient hospital stays require a $1,895 copay per stay, primary care visits, specialist consultations, and outpatient services feature no copay, with coinsurance ranging from 0% to 20%. Additionally, members pay no copay and no coinsurance for telehealth, home health care, and skilled nursing facility services. Beyond standard medical care, this plan provides valuable extra benefits, including up to $2,500 in annual dental coverage and a $250 vision allowance with no copay and no coinsurance. Members also benefit from covered hearing aids, fitness programs, and up to 24 one-way transportation trips per year at no cost. Additional perks like acupuncture, over-the-counter items, and routine physical exams are also covered with no copay and no coinsurance.
Inpatient Hospital See details
UHC Dual Complete WA-S1 (PPO D-SNP) partially covers inpatient hospital services, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days from coverage. Covered Medicare-approved acute and psychiatric hospital stays require prior authorization and have a $1,895 copayment per stay with no coinsurance.
Outpatient Services See details
UHC Dual Complete WA-S1 (PPO D-SNP) covers outpatient services with no copay, although prior authorization is required for most of these benefits. Members will pay a coinsurance ranging from no coinsurance to 20% for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services, and a flat 20% coinsurance for outpatient blood and observation services.
Partial Hospitalization See details
UHC Dual Complete WA-S1 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
UHC Dual Complete WA-S1 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, but trips to any health-related location are not covered.
Emergency Services See details
UHC Dual Complete WA-S1 (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 have a copay ranging from $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
Primary care and specialist services under UHC Dual Complete WA-S1 (PPO D-SNP) are covered with no copay and coinsurance ranging from 0% to 20%, depending on the service. Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered. Telehealth and opioid treatment services are covered with no copay and no coinsurance.
Preventive Services See details
UHC Dual Complete WA-S1 (PPO D-SNP) offers partially covered preventive services, with most benefits—including annual physical exams, fitness programs, and in-home support—available with no copay and no coinsurance. However, some services like digital rectal exams and post-Welcome Visit EKGs require a 20% coinsurance, and several options such as health education, personal emergency response systems (PERS), and nutritional benefits are not covered.
Hearing Services See details
UHC Dual Complete WA-S1 (PPO D-SNP) offers partially covered hearing services, including one routine hearing exam annually with a 20% coinsurance and no copay, though fitting and evaluation exams are not covered. Prescription and OTC hearing aids are covered with no copay and no coinsurance (up to two aids every two years with a $2,200 limit for prescription models), but inner-ear, outer-ear, and over-the-ear prescription types are excluded.
Vision Services See details
UHC Dual Complete WA-S1 (PPO D-SNP) offers partially covered vision services with no copay and no coinsurance, featuring one routine eye exam and contact lenses or a pair of eyeglasses per year up to a $250 combined maximum. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
UHC Dual Complete WA-S1 (PPO D-SNP) partially covers dental services, offering up to $2,500 in annual benefits for preventive and comprehensive care with no copay and no coinsurance. Medicare-covered dental services require a 20% coinsurance and no copay, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Dual Complete WA-S1 (PPO D-SNP) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete WA-S1 (PPO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
UHC Dual Complete WA-S1 (PPO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
UHC Dual Complete WA-S1 (PPO D-SNP) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and diagnostic radiological services with no copay and no coinsurance. Diagnostic procedures require a copay and a minimum 20% coinsurance, while outpatient X-rays and therapeutic radiological services have no copay but require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by UHC Dual Complete WA-S1 (PPO D-SNP) with no copay and no coinsurance. Prior authorization is required to access these services.
Cardiac Rehabilitation Services See details
UHC Dual Complete WA-S1 (PPO D-SNP) covers some services for cardiac rehabilitation with no copay and prior authorization, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete WA-S1 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. This benefit does not require a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UHC Dual Complete WA-S1 (PPO D-SNP) partially covers other services with no copay and no coinsurance, including up to 12 acupuncture treatments yearly, over-the-counter items, and chronic illness meal benefits. Prior authorization is required for the meal benefit, and some additional services under this benefit category are not covered.
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