Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete WV-S2 (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 WV-S2 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete WV-S2 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of West Virginia. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete WV-S2 (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 WV-S2 (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.
Below are a few key facts and commonly-asked questions about UHC Dual Complete WV-S2 (PPO D-SNP).
The cost of a Medicare Advantage Plan is made up of four main parts.
For UHC Dual Complete WV-S2 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $48.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.50. 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 $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.
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
The UHC Dual Complete WV-S2 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, the plan will cover the cost of your prescriptions until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your monthly Part D premium will be $48.40. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
The UHC Dual Complete WV-S2 (PPO D-SNP) plan offers a wide range of benefits with varying cost structures. The plan covers inpatient hospital stays with a $1665 copay per admission and also covers outpatient services and emergency services. Many services, like primary care, preventive services, hearing, vision, and dental, are covered with either no copay or a coinsurance, with some services having a $0 copay. This plan provides coverage for several services, including ambulance and transportation, partial hospitalization, home health, and skilled nursing facilities. While many services have no copay, others, such as inpatient hospital stays, have a fixed copay, and some services have a coinsurance, meaning you pay a percentage of the cost. The plan also includes benefits like home infusion, dialysis, medical equipment, and diagnostic and radiological services.
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a copay of $1665 per admission or stay, with no coinsurance. For Inpatient Hospital-Acute, additional days for days 91-999 have a copay of $0. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital Psychiatric, additional days and non-Medicare-covered stays are not covered.
Outpatient services are covered, including outpatient hospital services with a coinsurance of 0% - 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. Outpatient blood services are covered with a 20% coinsurance.
Partial Hospitalization is covered, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services are covered by the UHC Dual Complete WV-S2 (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UHC Dual Complete WV-S2 (PPO D-SNP) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a copay between $0 and $45 with no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, have no copay and no coinsurance.
Primary Care, including Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services, are covered. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and individual and group sessions for mental health and psychiatric services have a coinsurance of 0% to 20%. Chiropractic Services has a 20% coinsurance, and routine foot care has a 20% coinsurance. Additional Telehealth Benefits and Opioid Treatment Program Services have no copay.
Preventive services include annual physical exams with no copay, and additional preventive services, some of which may have a copay. Other preventive services like glaucoma screening, diabetes self-management training, and barium enemas have no copay, while digital rectal exams and EKG following Welcome Visit have 20% coinsurance.
The UHC Dual Complete WV-S2 (PPO D-SNP) plan covers hearing exams with a coinsurance of at most 20% and routine hearing exams with no copay, but does not cover fitting/evaluation for hearing aids. Prescription hearing aids are covered with no copay, and OTC hearing aids are covered with no copay.
The UHC Dual Complete WV-S2 (PPO D-SNP) plan covers vision services, including eye exams with no copay and eyewear with no copay. Eyeglasses (lenses and frames) and upgrades are not covered. Contact lenses, eyeglass lenses, and eyeglass frames have no copay. The plan offers a combined maximum of $200 per year for eyewear.
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. 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), oral and maxillofacial surgery, and maxillofacial prosthetics, all with no copay. Orthodontic Services are covered under Diagnostic and Preventive Dental. Implant Services and Orthodontics are not covered.
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%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services are covered under the UHC Dual Complete WV-S2 (PPO D-SNP) plan, and require prior authorization. The coinsurance for this service is 20%.
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is also covered, with coinsurance for Medicare-covered Diabetic Supplies and a copay for Medicare-covered Diabetic Therapeutic Shoes or Inserts.
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, and Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%. Lab Services have no copay.
Home Health Services are covered under the UHC Dual Complete WV-S2 (PPO D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered under this plan.
Cardiac Rehabilitation Services are covered, but not in practice, as Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required, and coinsurance information is available in the plan details.
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. You will pay the Medicare-defined cost share for tier 1.
Other Services include Over-the-Counter (OTC) Items and a Meal Benefit, with no copay for either. 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 are not covered.
SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
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