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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 2025, 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 out of 5 stars in 2025.
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 $50.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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 ND-S1 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $50.60.
Additional Benefits
The UHC Dual Complete ND-S1 (PPO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Hospital stays have a $1565 copay per admission, while outpatient services and primary care often have coinsurance between 0-20%. Many services have no copay, including preventive care, hearing exams, vision exams, dental services, home health services, and emergency services. This plan includes coverage for ambulance services, with a 20% coinsurance, and transportation to health-related locations with no copay. The plan also provides benefits for hearing aids, vision eyewear, and dental services, with no copay for many of these services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the UHC Dual Complete ND-S1 (PPO D-SNP) plan. For Inpatient Hospital-Acute, the copay for a Medicare-covered stay is $1565 per admission or stay, and additional days between days 91-999 have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital Psychiatric, the copay for a Medicare-covered stay is $1565 per admission or stay, but additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services for UHC Dual Complete ND-S1 (PPO D-SNP) include coverage for all outpatient hospital services, with a coinsurance between 0% and 20%, and observation services with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services have a coinsurance between 0% and 20%, while individual outpatient substance abuse sessions have a coinsurance between 0% and 20%, and group sessions have a 20% coinsurance. Outpatient Blood Services are covered with a 20% coinsurance, and the plan waives the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete ND-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, including ground and air ambulance services with a 20% coinsurance, and transportation services to a plan-approved health-related location 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 by the UHC Dual Complete ND-S1 (PPO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45; there is no coinsurance for either. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.
Primary Care See details
The UHC Dual Complete ND-S1 (PPO D-SNP) plan covers primary care physician services with a 0% to 20% coinsurance. Chiropractic services are covered with a 20% coinsurance, but routine care is not covered. Occupational therapy services have a 0% to 20% coinsurance, and there is no copay. The plan also covers physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services.
Preventive Services See details
Preventive Services include coverage for an annual physical exam with no copay, and other services such as glaucoma screenings, diabetes self-management training, and barium enemas with no copay. Digital rectal exams and EKG following Welcome Visit have a 20% coinsurance. Some services such as health education and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay and a 20% coinsurance, while fitting/evaluation for hearing aids is not covered. Prescription hearing aids have no copay, with a maximum benefit of $1500 every year, and OTC hearing aids have no copay.
Vision Services See details
The UHC Dual Complete ND-S1 (PPO D-SNP) plan covers vision services, including routine eye exams and eyewear. Routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames have no copay, while eyewear has a combined maximum plan benefit of $600 every year.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. 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), maxillofacial prosthetics, and prosthodontics (fixed) have no copay. Orthodontic Services are covered under Diagnostic and Preventive Dental. Implant Services and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the UHC Dual Complete ND-S1 (PPO D-SNP) plan, and prior authorization is required. You may have to pay a copay of $35 for Medicare Part B Insulin Drugs, and coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs, Other Medicare Part B Drugs, and Medicare Part B Insulin Drugs.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete ND-S1 (PPO D-SNP) plan and require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the UHC Dual Complete ND-S1 (PPO D-SNP) plan. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies also have a 20% coinsurance; Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. 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 ND-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, but not the Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a coinsurance for some cardiac and pulmonary rehabilitation services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and the copay information is listed separately.
Other Services See details
The UHC Dual Complete ND-S1 (PPO D-SNP) plan does not cover 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. Over-the-counter items and meal benefits are covered with no copay.
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