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UHC Dual Complete ND-S1 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete ND-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 ND-S1 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete ND-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 North Dakota. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that UHC Dual Complete ND-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 ND-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 ND-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 ND-S1 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.50. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.60. 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 ND-S1 (PPO D-SNP) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members enjoy no copay for one-month or three-month supplies at standard pharmacies and through standard mail order. This makes your most common medications highly accessible and budget-friendly. For all other drug categories—including Tier 2 generics, Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs—you will pay a 25% coinsurance. This 25% cost-sharing rate applies to both standard pharmacy fills and standard mail order deliveries. This straightforward pricing structure helps you easily plan for your monthly prescription expenses.
Additional Benefits
The UHC Dual Complete ND-S1 (PPO D-SNP) plan offers comprehensive medical coverage, including inpatient hospital stays with a $2,020 copay per admission and outpatient services with no copays and up to 20% coinsurance. Routine doctor visits, specialists, and telehealth services feature no copays, though some specialist visits may require up to 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted, while urgently needed services have a low copay ranging from no copay to $40. This plan also provides robust additional benefits, including preventive and comprehensive dental care up to $3,000 annually and routine vision care with a $400 yearly eyewear allowance, both with no copays or coinsurance. Members also benefit from hearing aid coverage up to $2,500 every two years, up to 36 routine one-way transportation trips per year, and over-the-counter items with no copays. Other essential services like home health care and skilled nursing facility stays are fully covered with no copays or coinsurance.
Inpatient Hospital See details
UHC Dual Complete ND-S1 (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $2,020 copay per admission and no coinsurance, requiring prior authorization. Unlimited additional acute care days are covered with no copay, but non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
UHC Dual Complete ND-S1 (PPO D-SNP) covers outpatient services with no copays, though coinsurance ranges from no coinsurance to 20% and prior authorization is required for most care. This includes outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no deductible applied to blood services.
Partial Hospitalization See details
UHC Dual Complete ND-S1 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UHC Dual Complete ND-S1 (PPO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
UHC Dual Complete ND-S1 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay of $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
UHC Dual Complete ND-S1 (PPO D-SNP) covers primary care, specialist, mental health, and psychiatric services with no copay and 0% to 20% coinsurance, while telehealth and opioid treatments have no copay and no coinsurance. Physical, occupational, speech therapy, and routine podiatry require no copay and 20% coinsurance, but chiropractic services are not covered.
Preventive Services See details
UHC Dual Complete ND-S1 (PPO D-SNP) covers preventive services with no copay and no coinsurance for annual physicals, kidney disease education, diabetes training, glaucoma screenings, and select fitness and home safety benefits. However, these benefits are only partially covered as digital rectal exams and EKGs require a 20% coinsurance, and several sub-services like health education, personal emergency response systems, and nutritional counseling are not covered.
Hearing Services See details
UHC Dual Complete ND-S1 (PPO D-SNP) features partially covered hearing exams with no deductible, no copay, and 20% coinsurance for annual routine exams, while fitting and evaluation services are not covered. Prescription hearing aids are also partially covered up to $2,500 every two years with no copay and no coinsurance, excluding inner ear, outer ear, and over the ear devices, while OTC hearing aids are covered with no copay and no coinsurance for up to two devices every two years.
Vision Services See details
UHC Dual Complete ND-S1 (PPO D-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible, featuring one routine eye exam per year and a $400 annual limit for eyewear. Other eye exam services, upgrades, and packaged eyeglasses (lenses and frames) are not covered, and prior authorization is required for eye exams.
Dental Services See details
Dental services are partially covered by UHC Dual Complete ND-S1 (PPO D-SNP), with implant services and orthodontics not being covered. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $3,000 annual maximum for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Dual Complete ND-S1 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and other infusion drugs, carry no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete ND-S1 (PPO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
UHC Dual Complete ND-S1 (PPO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies feature no copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance, with both requiring prior authorization and supplies limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete ND-S1 (PPO D-SNP) with prior authorization. Diagnostic procedures and tests require a copay and 20% coinsurance, while lab services have no copay. Radiological services require no copays, featuring no coinsurance for diagnostic radiology and a 20% minimum coinsurance for therapeutic radiology and outpatient X-rays.
Home Health Services See details
Home health services are covered under the UHC Dual Complete ND-S1 (PPO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
UHC Dual Complete ND-S1 (PPO D-SNP) covers Cardiac Rehabilitation Services with no copay, but only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by UHC Dual Complete ND-S1 (PPO D-SNP) with no copay and no coinsurance, requiring prior authorization. While the plan allows SNF admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by UHC Dual Complete ND-S1 (PPO D-SNP), which offers over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture and certain other services are not covered under this benefit, and the meal benefit requires prior authorization.
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