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UHC Dual Complete TX-D001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete TX-D001 (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 TX-D001 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete TX-D001 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in El Paso County. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete TX-D001 (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 TX-D001 (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 TX-D001 (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 TX-D001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $550.00 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 TX-D001 (PPO D-SNP) plan has an enhanced alternative drug benefit. The plan has a $550 deductible. After the deductible is met, you will pay coinsurance for your prescriptions, depending on the drug tier and pharmacy type. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The UHC Dual Complete TX-D001 (PPO D-SNP) plan offers comprehensive coverage with a focus on affordability. You'll pay a $2,000 copay for inpatient hospital stays, with no copay for additional days. Many services have no copay, including primary care, preventive services, hearing exams, dental services, home health, and over-the-counter items. The plan also includes coinsurance for some services, such as outpatient services, ambulance, and diagnostic services, typically ranging from 0% to 20%. Emergency services have a $110 copay, while other services like partial hospitalization have a $55 copay. Vision services include eye exams and contact lenses with no copay, as well as coverage for eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered, but require prior authorization. For Inpatient Hospital-Acute, there is a $2,000 copay per admission or stay, and additional days for inpatient hospital-acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a coinsurance between 0% and 20%, observation services with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services with a coinsurance between 0% and 20%. Outpatient Substance Abuse services include individual sessions with a coinsurance between 0% and 20% and group sessions with a 20% coinsurance. Outpatient Blood Services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. For this benefit, you will pay a $55 copay.
Ambulance and Transportation Services See details
The UHC Dual Complete TX-D001 (PPO D-SNP) plan covers ambulance services with a 20% coinsurance for both ground and air ambulance services, and transportation services 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 under the UHC Dual Complete TX-D001 (PPO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45, but both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with a coinsurance of 0-20%, Chiropractic Services with a 20% coinsurance, Occupational Therapy Services with a 0-20% coinsurance, Physician Specialist Services with a 0-20% coinsurance, Mental Health Specialty Services with a coinsurance of 0-20% for individual sessions and 20% for group sessions, Podiatry Services with a 20% coinsurance, Other Health Care Professional services with a 0-20% coinsurance, Psychiatric Services with a 0-20% coinsurance for individual sessions and 20% for group sessions, Physical Therapy and Speech-Language Pathology Services with a 0-20% coinsurance, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay. Routine Chiropractic Care has no copay.
Preventive Services See details
Preventive Services include no copay for annual physical exams, and for Medicare-covered zero dollar preventive services. Other preventive services, such as glaucoma screening, diabetes self-management training, and barium enemas, have no copay, while digital rectal exams and EKG following Welcome Visit have 20% coinsurance. Some services, such as Health Education, are not covered.
Hearing Services See details
Hearing services include coverage for routine hearing exams with no copay and at most 20% coinsurance, and prescription hearing aids with no copay and up to $2200 per year. OTC hearing aids are covered with no copay. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams and contact lenses have no copay, while eyewear has a combined maximum plan benefit coverage of $200 per year. Eyeglass lenses and frames are limited to one per year, and eyeglass frames, and contact lenses are not limited. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The UHC Dual Complete TX-D001 (PPO D-SNP) plan covers Medicare Dental Services with a 20% coinsurance. Other Dental Services include oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery, all with no copay. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization, and the coinsurance is 20%.
Medical Equipment See details
Medical Equipment is covered by the UHC Dual Complete TX-D001 (PPO D-SNP) plan, with a 20% coinsurance for Durable Medical Equipment (DME), Medicare-covered Prosthetic Devices, and Medicare-covered Medical Supplies. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by UHC Dual Complete TX-D001 (PPO D-SNP). Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and 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 TX-D001 (PPO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and you will pay the Medicare-defined cost share for tier 1, with more copay information available.
Other Services See details
The UHC Dual Complete TX-D001 (PPO D-SNP) plan covers acupuncture with no copay and covers Over-the-Counter (OTC) Items with no copay, including Nicotine Replacement Therapy (NRT) and Naloxone. However, the plan does not cover Meal Benefit, 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.
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