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UHC PathWays Dual Care IN-S3 (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-S3 (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-S3 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC PathWays Dual Care IN-S3 (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-S3 (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-S3 (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-S3 (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-S3 (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 $1.10. 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 PathWays Dual Care IN-S3 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are highly affordable, requiring no copay for 1-month or 3-month supplies at standard pharmacies and standard mail order. For Tier 2 generic, Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, members are responsible for a 25% coinsurance. This 25% coinsurance applies to standard pharmacy and standard mail order fills, helping you easily estimate your out-of-pocket prescription costs.
Additional Benefits
The UHC PathWays Dual Care IN-S3 (PPO D-SNP) plan offers comprehensive coverage with no copay and no coinsurance for inpatient hospital stays, skilled nursing care, and primary or specialist doctor visits. Outpatient procedures, diagnostic services, and medical equipment generally require no copay, though some services and dialysis carry a 20% coinsurance. Emergency room visits require a $115 copay, which is waived upon admission, while urgent care services feature a copay ranging from no copay up to $40. This plan also includes valuable everyday benefits, such as no copay for routine dental, vision, and hearing exams, along with generous allowances for eyewear and prescription hearing aids. Furthermore, members receive no-copay coverage for over-the-counter items and up to 48 one-way trips per year to plan-approved locations. These extra benefits help lower out-of-pocket costs for essential wellness services and daily health management.
Inpatient Hospital See details
UHC PathWays Dual Care IN-S3 (PPO D-SNP) covers inpatient hospital services with no copay and no coinsurance, although prior authorization is required. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
UHC PathWays Dual Care IN-S3 (PPO D-SNP) covers outpatient services with no copays, though coinsurance ranges from no coinsurance up to 20% depending on the specific service. Prior authorization is required for most of these outpatient services, which include ambulatory surgical center visits, outpatient hospital services, substance abuse sessions, and blood services.
Partial Hospitalization See details
UHC PathWays Dual Care IN-S3 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UHC PathWays Dual Care IN-S3 (PPO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services. Transportation services are partially covered with no copay and no coinsurance for up to 48 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
UHC PathWays Dual Care IN-S3 (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 and 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-S3 (PPO D-SNP) covers primary care, specialist, telehealth, therapy, and opioid treatment services with no copays and no coinsurance. Mental health, psychiatric, and podiatry services are covered with no copays and coinsurance ranging up to 20%, while chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by UHC PathWays Dual Care IN-S3 (PPO D-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, and fitness benefits. Additional preventive services are partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, smoking cessation counseling, disease management, telemonitoring, remote access technologies, and counseling. Medicare-covered digital rectal exams and post-welcome visit EKGs are covered with a 20% coinsurance and no copay, while glaucoma screenings and diabetes self-management training require no copay.
Hearing Services See details
Hearing services are partially covered by UHC PathWays Dual Care IN-S3 (PPO D-SNP) with no deductible; routine hearing exams have no copay and 20% coinsurance, while fitting and evaluation exams are not covered. Up to two prescription or OTC hearing aids are covered every two years with no copay and no coinsurance (up to a $3,200 limit for prescription aids), but inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by UHC PathWays Dual Care IN-S3 (PPO D-SNP), offering no copay and no coinsurance for covered services, which include one routine eye exam, eyeglass lenses, eyeglass frames, and contact lenses up to a $300 annual limit. Other eye exam services, eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
UHC PathWays Dual Care IN-S3 (PPO D-SNP) covers Medicare-covered dental services with no copay and a 20% coinsurance, while other preventive and comprehensive dental benefits are partially covered with no copay and no coinsurance up to a $5,000 annual maximum. Implant services and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC PathWays Dual Care IN-S3 (PPO D-SNP) with no copay, requiring prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and up to 20% coinsurance (with no minimum coinsurance), while Part B insulin requires a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC PathWays Dual Care IN-S3 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by UHC PathWays Dual Care IN-S3 (PPO D-SNP) with a 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the UHC PathWays Dual Care IN-S3 (PPO D-SNP) plan with no copay and no coinsurance for lab services, diagnostic procedures, and diagnostic radiological services. Outpatient X-ray services feature no copay but require coinsurance, while therapeutic radiological services require a minimum 20% coinsurance, with prior authorization required for all services.
Home Health Services See details
UHC PathWays Dual Care IN-S3 (PPO D-SNP) offers coverage for home health services with no copay and no coinsurance. Please note that prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
UHC PathWays Dual Care IN-S3 (PPO D-SNP) offers coverage for some Cardiac Rehabilitation Services with prior authorization, though cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Covered cardiac and intensive cardiac rehabilitation services require a 20% coinsurance, while pulmonary and SET for PAD services have no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by UHC PathWays Dual Care IN-S3 (PPO D-SNP) with no copay and no coinsurance, though additional days beyond the standard Medicare-covered limit are not covered. Prior authorization is required for these services, but a prior three-day inpatient hospital stay is not.
Other Services See details
Other services under UHC PathWays Dual Care IN-S3 (PPO D-SNP) are partially covered, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required for the meal benefit.
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