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UHC Dual Complete HI-Y1 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete HI-Y1 (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 HI-Y1 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete HI-Y1 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of Hawaii. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete HI-Y1 (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 HI-Y1 (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 HI-Y1 (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 HI-Y1 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $47.70. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.40. 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 $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 $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 HI-Y1 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy, your Part D premium may be reduced. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered drugs.
Additional Benefits
The UHC Dual Complete HI-Y1 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a high copay, while outpatient services and specialist visits often involve coinsurance. Emergency, urgent, and worldwide emergency services have no copay. Preventive services, including annual physical exams, have no copay, and vision services offer no copay for eye exams and eyewear. Dental services cover a variety of procedures with no copay, up to an annual maximum. The plan also includes home health, and home infusion services, and offers coverage for medical equipment, diagnostic services, and dialysis with varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization, with a copay of $1575 per admission or stay for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute has a copay of $0 for days 91-999, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, along with Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services are covered, with varying coinsurance depending on the service. Outpatient Hospital Services have a coinsurance of 0% to 20%, Observation Services have a 20% coinsurance, Ambulatory Surgical Center (ASC) Services have a coinsurance of 0% to 20%, Individual Sessions for Outpatient Substance Abuse have a coinsurance of 0% to 20%, Group Sessions for Outpatient Substance Abuse have a 20% coinsurance, and Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations 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 by the UHC Dual Complete HI-Y1 (PPO D-SNP) plan. Emergency Services have a $110 copay and no coinsurance. Urgently Needed Services have a copay between $0 and $45 and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay and no coinsurance.
Primary Care See details
The UHC Dual Complete HI-Y1 (PPO D-SNP) plan covers primary care services with a coinsurance between 0% and 20%. Chiropractic services are covered with a 20% coinsurance, and routine chiropractic care has no copay. Occupational therapy services are covered with a coinsurance between 0% and 20%. Physician specialist services have a coinsurance between 0% and 20%, and mental health specialty services, individual sessions for psychiatric services, and group sessions for psychiatric services are covered with varying coinsurance amounts. Podiatry services are covered with a coinsurance of 20%, while Medicare-covered podiatry services have no copay. Other health care professional services are covered with a coinsurance between 0% and 20%. Physical therapy and speech-language pathology services are covered with a coinsurance between 0% and 20%. Additional telehealth benefits and opioid treatment program services are covered with no copay.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, and additional preventive services including Fitness Benefit, Home and Bathroom Safety Devices and Modifications. Annual Physical Exams have no copay, while Glaucoma Screenings, Diabetes Self-Management Training, and Barium Enemas also have no copay. Digital Rectal Exams and EKG following Welcome Visit have 20% coinsurance.
Hearing Services See details
Hearing Services are partially covered under the UHC Dual Complete HI-Y1 (PPO D-SNP) plan. Hearing exams are covered with at most 20% coinsurance, while routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by the UHC Dual Complete HI-Y1 (PPO D-SNP) plan, with no copay for eye exams and eyewear. However, routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance and Other Dental Services with a maximum benefit of $4000 per year. Oral Exams, Dental X-Rays, Other Diagnostic, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services are covered with no copay, but have visit limits and varying periodicity. Restorative, Adjunctive General, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery are covered with no copay but are subject to prior authorization and have visit limits and varying periodicity. However, Implant Services and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For both Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment is covered by the UHC Dual Complete HI-Y1 (PPO D-SNP) plan, with Durable Medical Equipment (DME) subject to 14% coinsurance and requiring authorization. Prosthetic devices and medical supplies also have 14% coinsurance, while diabetic supplies have no copay and Diabetic Therapeutic Shoes/Inserts have 14% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the UHC Dual Complete HI-Y1 (PPO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%. Lab Services have no copay.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete HI-Y1 (PPO D-SNP) plan with no copay and no coinsurance. 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 Dual Complete HI-Y1 (PPO D-SNP) plan. Prior authorization is required for these services, but none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and the copay information is available below.
Other Services See details
Under "Other Services", acupuncture is covered with no copay, but is limited to 20 treatments per year. Over-the-counter items are covered with no copay, including nicotine replacement therapy and naloxone, but does not cover all drugs on the CMS OTC list. Some other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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