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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 2026, 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 2026.
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 $121.00 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 Dual Complete TX-D001 (PPO D-SNP) Medicare plan features an annual prescription drug deductible of $121. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order. This makes essential generic prescriptions highly affordable for members looking to manage their healthcare costs. For higher-tier medications, including Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, members are responsible for a 25% coinsurance at standard pharmacies and through standard mail order. This consistent cost-sharing structure helps you easily predict your out-of-pocket expenses for brand-name and specialty prescriptions.
Additional Benefits
The UHC Dual Complete TX-D001 (PPO D-SNP) offers comprehensive medical coverage featuring no copay for primary care, outpatient services, and home health care, though some services require a coinsurance up to 20%. Inpatient hospital stays require a copay of $2,230 for acute care and $2,080 for psychiatric care, while emergency room visits carry a $115 copay. Most routine and preventive services, including annual physicals and fitness programs, are fully covered with no copay or coinsurance. This plan also includes valuable supplemental benefits such as dental care and vision coverage with no copay, featuring a $1,500 annual limit for dental services and a $200 annual allowance for eyewear. Additionally, members benefit from hearing aid coverage up to $2,200 every two years, up to 24 one-way transportation trips annually, and no-copay over-the-counter items. Many specialized services, including medical equipment and dialysis, are covered with a standard 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by UHC Dual Complete TX-D001 (PPO D-SNP) with no coinsurance and require prior authorization, featuring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Unlimited additional acute days are covered with no copay, but upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
UHC Dual Complete TX-D001 (PPO D-SNP) covers outpatient services with no copay, though a coinsurance ranging from no coinsurance up to 20% may apply depending on the service. This coverage includes outpatient hospital care, ambulatory surgical center services, substance abuse sessions, and outpatient blood services, which generally require prior authorization.
Partial Hospitalization See details
UHC Dual Complete TX-D001 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
UHC Dual Complete TX-D001 (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 with no copay or coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, but transportation to any health-related location is not covered.
Emergency Services See details
UHC Dual Complete TX-D001 (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 carry a copay of $0 to $40 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copays and no coinsurance.
Primary Care See details
Primary Care benefits through UHC Dual Complete TX-D001 (PPO D-SNP) are covered with no copay and 0% to 20% coinsurance for doctor visits, specialist care, and therapy services. Telehealth and opioid treatment sessions are available with no copay and no coinsurance, while chiropractic services are only partially covered as routine chiropractic care is not covered.
Preventive Services See details
UHC Dual Complete TX-D001 (PPO D-SNP) offers partially covered preventive services, featuring no copay and no coinsurance for annual physicals, kidney disease education, fitness programs, weight management, and in-home support. Digital rectal exams and post-welcome visit EKGs require a 20% coinsurance and no copay, while sub-services including health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, smoking cessation, disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete TX-D001 (PPO D-SNP), offering one annual routine hearing exam with a 20% coinsurance and no copay, though hearing aid fitting and evaluations are not covered. Prescription hearing aids are covered with no copay and no coinsurance up to $2,200 every two years, but inner ear, outer ear, and over-the-ear devices are not covered. Up to two OTC hearing aids are also covered every two years with no copay and no coinsurance.
Vision Services See details
Vision services are covered by UHC Dual Complete TX-D001 (PPO D-SNP) with no copay, no coinsurance, and no deductible, including a $200 annual maximum benefit for eyewear. The benefit is partially covered because other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by UHC Dual Complete TX-D001 (PPO D-SNP), featuring Medicare-covered dental care with no copay and 20% coinsurance. Other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a $1,500 annual limit, though implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Dual Complete TX-D001 (PPO D-SNP) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete TX-D001 (PPO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
UHC Dual Complete TX-D001 (PPO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
UHC Dual Complete TX-D001 (PPO D-SNP) covers diagnostic and radiological services under prior authorization, with diagnostic tests requiring a copayment and 20% minimum coinsurance, and lab services requiring no copay. Radiological services have no copayments, featuring no coinsurance for diagnostic radiology and a 20% minimum coinsurance for therapeutic radiology and outpatient X-rays.
Home Health Services See details
Home health services are covered by UHC Dual Complete TX-D001 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by UHC Dual Complete TX-D001 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete TX-D001 (PPO D-SNP) offers partially covered Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan allows SNF admission without a prior three-day hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by UHC Dual Complete TX-D001 (PPO D-SNP), with acupuncture, meal benefits, and highly integrated services excluded from coverage. Over-the-Counter (OTC) items, including nicotine replacement therapy and naloxone, are covered with no copay and no coinsurance.
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