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UHC Complete Care Support FG-5 (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Complete Care Support FG-5 (PPO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Complete Care Support FG-5 (PPO C-SNP) in 2025, please refer to our full plan details page.
UHC Complete Care Support FG-5 (PPO C-SNP) is a PPO C-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in Minnesota and North Dakota. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Complete Care Support FG-5 (PPO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
UHC Complete Care Support FG-5 (PPO C-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 Complete Care Support FG-5 (PPO C-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 Complete Care Support FG-5 (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.60. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $8400.00 (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 $8400.00 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 Complete Care Support FG-5 (PPO C-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly Part D premium will be $36.60. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Complete Care Support FG-5 (PPO C-SNP) plan offers comprehensive coverage with a variety of benefits. This plan includes inpatient hospital stays with a copay, outpatient services with varying copays, and no copay for primary care physician services. Additionally, the plan covers ambulance services with a copay, emergency services with a copay, and offers vision and dental benefits. Preventive services like annual physical exams have no copay, and hearing exams and prescription hearing aids are covered with a copay. The plan also includes coverage for home infusion services, medical equipment, and diagnostic services with copays or coinsurance. Other benefits include no copay for home health services, and skilled nursing facility stays with a copay.
Inpatient Hospital See details
Inpatient Hospital benefits for UHC Complete Care Support FG-5 (PPO C-SNP) include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $495 copay for days 1-5, and no copay for days 6-90, while additional days have no copay; Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, there is a $495 copay for days 1-4, and no copay for days 5-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
The UHC Complete Care Support FG-5 (PPO C-SNP) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $495, observation services with a $495 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a copay between $0 and $15 for individual sessions and a $15 copay for group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Complete Care Support FG-5 (PPO C-SNP) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Complete Care Support FG-5 (PPO C-SNP) plan, including both ground and air ambulance services with a $290 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 Complete Care Support FG-5 (PPO C-SNP) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $55; Worldwide Emergency, Urgent, and Transportation services have no copay.
Primary Care See details
Under the UHC Complete Care Support FG-5 (PPO C-SNP) plan, primary care physician services have no copay, while chiropractic services have a $20 copay. Occupational therapy services have a copay between $0 and $45, and physician specialist services have a copay between $0 and $45. Mental health specialty services have a $0-$15 copay for individual sessions and a $15 copay for group sessions, while podiatry services have a $40 copay. Other health care professional services have a copay between $0 and $45, and psychiatric services have a $0-$15 copay for individual sessions and a $15 copay for group sessions. Physical therapy and speech-language pathology services have a copay between $0 and $50, and additional telehealth benefits have no copay. Opioid treatment program services have no copay.
Preventive Services See details
Preventive Services include annual physical exams with no copay, along with additional preventive services. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services.
Hearing Services See details
The UHC Complete Care Support FG-5 (PPO C-SNP) plan covers hearing exams with no copay, and routine hearing exams with no copay for one visit every year. Prescription hearing aids are covered, with a copay between $199 and $1249 for two hearing aids every year, while OTC hearing aids have a copay between $99 and $829 for two hearing aids annually. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
The UHC Complete Care Support FG-5 (PPO C-SNP) plan covers vision services, including eye exams with no copay, and eyewear with a combined maximum of $250 every two years. Contact lenses, eyeglass lenses, and eyeglass frames are covered with no copay, but eyeglass lenses have a copay of $0-$153. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Complete Care Support FG-5 (PPO C-SNP) plan covers dental services, with a 20% coinsurance for Medicare dental services. Oral exams, dental X-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with 20% coinsurance and prosthetics/medical supplies with 20% coinsurance. Diabetic equipment is covered, and diabetic supplies and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a $40 copay, lab services with no copay, and outpatient X-Ray services with a $25 copay. Diagnostic radiological services have a copay of at most $250, and therapeutic radiological services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the UHC Complete Care Support FG-5 (PPO C-SNP) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the UHC Complete Care Support FG-5 (PPO C-SNP) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the UHC Complete Care Support FG-5 (PPO C-SNP) plan. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other services include Over-the-Counter (OTC) Items and Meal Benefits, both with no copay. 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.
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