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UHC Dual Complete WA-Q1 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete WA-Q1 (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-Q1 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete WA-Q1 (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-Q1 (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-Q1 (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-Q1 (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-Q1 (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-Q1 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, your costs depend on the drug tier and pharmacy you use, but the specific costs are not listed in this summary. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), with a monthly premium of $26.20. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The UHC Dual Complete WA-Q1 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1780 copay, while outpatient services and ambulance services have coinsurance between 0% and 20%. Many services are covered with no copay, including preventive care, routine hearing and vision exams, dental cleanings, and home health services. This plan also includes coverage for hearing aids, eyewear, and other dental services with no copay, and a $1500 annual maximum. Additionally, the plan offers benefits like acupuncture, OTC items, and a meal benefit for chronic illness with no copay.
Inpatient Hospital See details
The UHC Dual Complete WA-Q1 (PPO D-SNP) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $1780 per admission or stay. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a coinsurance of 0% to 20%, Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a coinsurance between 0% and 20%, Outpatient Substance Abuse Services with a coinsurance between 0% and 20% for individual sessions and a 20% coinsurance for group sessions, and Outpatient Blood Services with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete WA-Q1 (PPO D-SNP) plan. The copay for this benefit is $55.
Ambulance and Transportation Services See details
The UHC Dual Complete WA-Q1 (PPO D-SNP) plan covers ambulance services with a 20% coinsurance for both ground and air ambulance services, as well as transportation services with no copay. Transportation services to any health-related location are covered, but transportation services to any health-related location are limited to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UHC Dual Complete WA-Q1 (PPO D-SNP) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a copay between $0 and $45. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Primary Care Physician Services are covered with a coinsurance of 0% - 20%. Chiropractic Services are covered, but require prior authorization and have a 20% coinsurance. Routine Chiropractic Care has no copay, but other Chiropractic Services have a copay.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services are covered, with no copay for glaucoma screening, diabetes self-management training, and barium enemas, and a 20% coinsurance for digital rectal exams and EKG following a welcome visit.
Hearing Services See details
Hearing Services includes coverage for hearing exams and prescription hearing aids, with Routine Hearing Exams covered with no copay and a 20% coinsurance, and Prescription Hearing Aids (all types) covered with no copay. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are also covered with no copay.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear has no copay, and includes contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum of $200 per year for both in and out-of-network services; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a maximum benefit of $1500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery are covered with no copay, but Implant Services and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and between 0% to 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete WA-Q1 (PPO D-SNP) plan and require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a coinsurance for Diagnostic Procedures/Tests and Diagnostic Radiological Services of at most 20%, and a coinsurance of at most 20% for Therapeutic Radiological Services and Outpatient X-Ray Services. Lab Services have no copay.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete WA-Q1 (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, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. This benefit requires prior authorization, and coinsurance information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered days or non-Medicare-covered stays. Prior authorization is required, and you will be responsible for the Medicare-defined cost share for tier 1.
Other Services See details
Under "Other Services," the UHC Dual Complete WA-Q1 (PPO D-SNP) plan covers acupuncture with no copay, and up to 12 treatments per year. Over-the-counter (OTC) items are covered with no copay, including nicotine replacement therapy and Naloxone, but not all drugs on the CMS OTC list. The plan also offers a meal benefit with no copay for a chronic illness, but does require prior authorization. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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