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UHC PathWays Dual Care IN-S1 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC PathWays Dual Care IN-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 PathWays Dual Care IN-S1 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC PathWays Dual Care IN-S1 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2026 to people living in State of Indiana. The overall rating for this plan is not yet available for 2026.
It's important to know that UHC PathWays Dual Care IN-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 PathWays Dual Care IN-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 PathWays Dual Care IN-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 PathWays Dual Care IN-S1 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.30. 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:
Sign up for UHC PathWays Dual Care IN-S1 (PPO D-SNP)
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Drug Coverage
The UHC PathWays Dual Care IN-S1 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies, as well as no copay for a 3-month supply through standard mail order. Tier 2 generic drugs require a 25% coinsurance for both 1-month and 3-month fills at standard pharmacies and standard mail order. Tier 3 preferred brand drugs are also subject to a 25% coinsurance for 1-month and 3-month supplies through standard pharmacies and mail order. Additionally, Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply from standard pharmacies or standard mail order. This plan provides clear, tier-based pricing to help you manage your healthcare budget.
Additional Benefits
The UHC PathWays Dual Care IN-S1 (PPO D-SNP) plan offers comprehensive coverage for essential medical services, often with no copay. Primary care visits, outpatient services, and home health care require no copay, though some outpatient and specialist services may carry a coinsurance of up to 20%. For hospital stays, members pay a copay of $2,180 per acute stay and $2,080 per psychiatric stay, but with no coinsurance. Additional benefits include dental, vision, and hearing coverage, featuring no copays for routine exams and preventive services. Dental care is covered up to a $2,500 annual limit, while vision hardware has a $250 annual allowance, and select hearing aids are covered every two years with no copay or coinsurance. Members also benefit from up to 36 one-way transportation trips per year and over-the-counter benefits with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by UHC PathWays Dual Care IN-S1 (PPO D-SNP) with no coinsurance, requiring prior authorization and a copay of $2,180 per acute stay and $2,080 per psychiatric stay. While unlimited additional acute days are covered with no copay, this plan does not cover upgrades, non-Medicare-covered stays, or additional psychiatric days.
Outpatient Services See details
UHC PathWays Dual Care IN-S1 (PPO D-SNP) covers outpatient services with no copay, with coinsurance ranging from no coinsurance up to 20% depending on the service. Covered benefits include outpatient hospital, ambulatory surgical center, substance abuse, and blood services, most of which require prior authorization.
Partial Hospitalization See details
Partial hospitalization is covered by UHC PathWays Dual Care IN-S1 (PPO D-SNP) with a $55.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
UHC PathWays Dual Care IN-S1 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, providing up to 36 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
UHC PathWays Dual Care IN-S1 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature a copay ranging from $0 to $40 with no coinsurance, while worldwide emergency, urgent, and transportation services are provided with no copay and no coinsurance.
Primary Care See details
UHC PathWays Dual Care IN-S1 (PPO D-SNP) covers primary care, specialist, therapy, psychiatric, and podiatry services with no copays and coinsurance ranging from 0% to 20%. Telehealth and opioid treatment services are available with no copay and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by UHC PathWays Dual Care IN-S1 (PPO D-SNP), with most services like annual physical exams and fitness benefits requiring no copay and no coinsurance, while digital rectal exams and EKGs require a 20% coinsurance. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are partially covered by UHC PathWays Dual Care IN-S1 (PPO D-SNP), offering one annual routine hearing exam with no copay and a 20% coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids (excluding inner ear, outer ear, and over the ear types) up to a $2,200 limit and up to two OTC hearing aids are covered every two years with no copay or coinsurance.
Vision Services See details
UHC PathWays Dual Care IN-S1 (PPO D-SNP) partially covers vision services with no copay and no coinsurance, which includes one routine eye exam per year and a $250 annual limit for contacts, eyeglass lenses, and frames. Upgrades, other eye exam services, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by UHC PathWays Dual Care IN-S1 (PPO D-SNP), which offers up to a $2,500 annual maximum benefit for both in-network and out-of-network care. Medicare-covered dental services require no copay and a 20% coinsurance, while other preventive and comprehensive services have no copay and no coinsurance, though implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC PathWays Dual Care IN-S1 (PPO D-SNP) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
UHC PathWays Dual Care IN-S1 (PPO D-SNP) covers dialysis services with no copay and a 20% coinsurance, subject to prior authorization.
Medical Equipment See details
UHC PathWays Dual Care IN-S1 (PPO D-SNP) covers durable medical equipment, prosthetics, and diabetic supplies with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
UHC PathWays Dual Care IN-S1 (PPO D-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic radiological services are available with no copay or coinsurance, while lab services have no copay, diagnostic tests require a copay and 20% coinsurance, and therapeutic radiology and outpatient X-rays have no copay but require a 20% minimum coinsurance.
Home Health Services See details
Home Health Services are covered under the UHC PathWays Dual Care IN-S1 (PPO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the UHC PathWays Dual Care IN-S1 (PPO D-SNP) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are all not covered. These services require prior authorization and carry a 20% coinsurance with no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UHC PathWays Dual Care IN-S1 (PPO D-SNP) with no copay or coinsurance, and prior authorization is required. The plan does not require a 3-day prior hospital stay for admission, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by UHC PathWays Dual Care IN-S1 (PPO D-SNP), featuring Over-the-Counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture is not covered under this benefit, and prior authorization is required for the meal benefit.
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