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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 2026, 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 4.5 out of 5 stars in 2026.
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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.50. 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 $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:
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Drug Coverage
The UHC Dual Complete WA-Q1 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members benefit from no copay for 1-month and 3-month supplies at standard pharmacies and standard mail order. Tier 2 generic medications require a 15% coinsurance for both 1-month and 3-month supplies through standard pharmacy and mail order channels. For brand-name and specialized medications, the plan utilizes a coinsurance model. Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty tier drugs all carry a 25% coinsurance for standard pharmacy and mail order fills. This straightforward structure makes it easy to estimate your out-of-pocket costs for prescriptions under this UHC plan.
Additional Benefits
The UHC Dual Complete WA-Q1 (PPO D-SNP) plan offers comprehensive medical coverage with various cost-sharing options. Inpatient hospital stays require a $2,070 copay with no coinsurance, while primary care visits and outpatient services generally feature no copay and coinsurance ranging from 0% to 20%. Emergency room visits carry a $115 copay, which is waived if you are admitted, and urgent care services have a low copay of $0 to $40. This plan also provides robust supplemental benefits, including dental, vision, and hearing care with no copay and up to specific annual dollar allowances. Additionally, members can access home health services, skilled nursing facility care, and over-the-counter items with no copay and no coinsurance. Routine transportation is also covered for up to 24 one-way trips per year at no cost to help you reach plan-approved locations.
Inpatient Hospital See details
UHC Dual Complete WA-Q1 (PPO D-SNP) partially covers inpatient hospital services with a $2,070 copay per stay and no coinsurance for Medicare-covered acute and psychiatric stays, both requiring prior authorization. While unlimited additional acute days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
UHC Dual Complete WA-Q1 (PPO D-SNP) covers outpatient services, including hospital, ambulatory surgical center, substance abuse, and blood services, with no copays and coinsurance ranging from 0% to 20%. Prior authorization is required for these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
UHC Dual Complete WA-Q1 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
UHC Dual Complete WA-Q1 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, but trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by UHC Dual Complete WA-Q1 (PPO D-SNP) with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services carry a copay of $0 to $40 and no coinsurance, while worldwide emergency, urgent, and transportation services are provided with no copay and no coinsurance.
Primary Care See details
Primary care benefits under UHC Dual Complete WA-Q1 (PPO D-SNP) are partially covered, featuring no copay for most services and coinsurance ranging from 0% to 20%. While routine chiropractic care, specialist visits, and therapy are covered, other chiropractic services are not covered.
Preventive Services See details
UHC Dual Complete WA-Q1 (PPO D-SNP) partially covers preventive services, offering annual physical exams, kidney disease education, and fitness benefits with no copay and no coinsurance, while digital rectal exams and post-welcome visit EKGs require a 20% coinsurance. Multiple supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, alternative therapies, and nutritional benefits.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete WA-Q1 (PPO D-SNP), offering annual routine hearing exams with no copay and 20% coinsurance, though fitting and evaluation services are not covered. Prescription and OTC hearing aids are covered with no copay and no coinsurance for up to two devices every two years with a $1,500 limit for prescription aids, but inner ear, outer ear, and over-the-ear prescription models are excluded.
Vision Services See details
Vision Services are partially covered by UHC Dual Complete WA-Q1 (PPO D-SNP), providing one routine eye exam and select eyewear with no copay and no coinsurance up to a $150 annual limit. While contact lenses and complete eyeglasses are covered, other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
UHC Dual Complete WA-Q1 (PPO D-SNP) partially covers dental services, which includes Medicare-covered dental care with no copay and a 20% coinsurance, alongside preventive and comprehensive dental care with no copay and no coinsurance up to a $1,500 annual maximum. Implant services and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
UHC Dual Complete WA-Q1 (PPO D-SNP) covers home infusion bundled services with no copay and no coinsurance, although prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a 0% to 20% coinsurance, while Part B insulin is subject to a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by UHC Dual Complete WA-Q1 (PPO D-SNP) 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 Dual Complete WA-Q1 (PPO D-SNP) with no copayments for durable medical equipment (DME), prosthetics, and diabetic supplies. A 20% coinsurance applies to DME, medical supplies, prosthetics, and diabetic therapeutic shoes or inserts, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
UHC Dual Complete WA-Q1 (PPO D-SNP) covers diagnostic and radiological services with prior authorization required, offering diagnostic radiological services with no copay and no coinsurance, and lab services with no copay. Covered diagnostic tests, therapeutic radiology, and outpatient X-rays require a 20% coinsurance, and diagnostic tests also require a copayment.
Home Health Services See details
Home Health Services are covered by UHC Dual Complete WA-Q1 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by UHC Dual Complete WA-Q1 (PPO D-SNP) with no copay and 20% coinsurance, subject to prior authorization. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete WA-Q1 (PPO D-SNP) covers Skilled Nursing Facility (SNF) care with no copayment and no coinsurance, although prior authorization is required. The plan allows SNF admission without 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-Q1 (PPO D-SNP) covers acupuncture for up to 12 treatments per year, over-the-counter (OTC) items, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for the meal benefit, and some other miscellaneous services are not covered.
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