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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 2025, 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 out of 5 stars in 2025.
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 $26.20. 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 WA-S1 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), also known as "Extra Help", your Part D premium will be $26.20. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The UHC Dual Complete WA-S1 (PPO D-SNP) plan offers a range of benefits including hospital stays, outpatient services, and primary care, with varying cost-sharing. For hospital stays, there is a $2,000 copay per admission. Outpatient services often have coinsurance between 0% and 20%, while primary care services can have coinsurance. The plan also provides coverage for preventive services, hearing, vision, and dental care. Routine hearing exams and eye exams have no copay, with a yearly benefit for hearing aids and eyewear. Dental services are covered with no copay for many services, and other services such as ambulance, home health, and some medical equipment are covered with varying costs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a $2,000 copay per admission or stay. Additional Days for Inpatient Hospital-Acute has no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, ambulatory surgical center services, and outpatient substance abuse services, are covered by this plan. Outpatient Hospital Services have a coinsurance between 0% and 20%, Observation Services have a 20% coinsurance, and Ambulatory Surgical Center Services have a coinsurance between 0% and 20%. Outpatient Substance Abuse individual sessions have a coinsurance between 0% and 20%, and group sessions have a 20% coinsurance. Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete WA-S1 (PPO D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services to plan-approved health-related locations are covered with no copay. 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. For Emergency Services, the copay is $110, but is waived if admitted to the hospital within 24 hours; there is no coinsurance. Urgently Needed Services have a copay between $0 and $45, and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay and no coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with a 0% to 20% coinsurance, Chiropractic Services with a 20% coinsurance and copays for some services, Occupational Therapy Services with a 0% to 20% coinsurance, Physician Specialist Services with a 0% to 20% coinsurance, Mental Health Specialty Services with varying coinsurance, Podiatry Services with a 20% coinsurance and copays for some services, Other Health Care Professional with a 0% to 20% coinsurance, Psychiatric Services with varying coinsurance, Physical Therapy and Speech-Language Pathology Services with a 0% to 20% coinsurance, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay. Routine Chiropractic Care has no copay, and Routine Foot Care has a limit of 4 visits per year with no copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, and other preventive services, such as glaucoma screening, diabetes self-management training, and barium enemas, with no copay. Digital rectal exams and EKG following Welcome Visit have a 20% coinsurance. Other services such as health education, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids, with routine hearing exams covered with no copay and at most 20% coinsurance, and prescription hearing aids covered with a yearly benefit of $2200. OTC hearing aids are also covered with no copay.
Vision Services See details
The UHC Dual Complete WA-S1 (PPO D-SNP) plan covers vision services including routine eye exams and eyewear. Eye exams and contact lenses have no copay, while eyeglasses (lenses and frames) and upgrades are not covered. You are eligible for one routine eye exam per year, and one pair of eyeglass lenses and one eyeglass frame per year. The plan offers a combined maximum of $300 per year for eyewear.
Dental Services See details
Dental services are covered, with Medicare dental services requiring prior authorization and a 20% coinsurance. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery, all with no copay. However, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying copays and coinsurance. Durable Medical Equipment for use outside the home is not covered, while Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by UHC Dual Complete WA-S1 (PPO D-SNP). Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay. 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 WA-S1 (PPO D-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 Dual Complete WA-S1 (PPO D-SNP) plan, but none of the specific services are covered. Prior authorization is required for this benefit, and there is coinsurance for some services, though the details are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan does not provide additional days beyond Medicare-covered SNF services, and non-Medicare-covered SNF stays are not covered. The copay for SNF services is not specified.
Other Services See details
Under the UHC Dual Complete WA-S1 (PPO D-SNP) plan, acupuncture and over-the-counter items have no copay, and the plan covers up to 12 acupuncture treatments per year. Meal benefits are also covered with no copay, but require prior authorization. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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