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UHC Dual Complete NJ-Y001 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete NJ-Y001 (HMO 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 NJ-Y001 (HMO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete NJ-Y001 (HMO D-SNP) is a HMO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in New Jersey. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that UHC Dual Complete NJ-Y001 (HMO 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 NJ-Y001 (HMO 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 NJ-Y001 (HMO 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 NJ-Y001 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $37.20. 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 $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 Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 NJ-Y001 (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Specific drug tier details, including individual copayments and coinsurance rates for this plan, are currently unavailable. To fully understand your potential out-of-pocket costs, it is important to verify how your specific prescriptions are classified under this plan's formulary.
Additional Benefits
The UHC Dual Complete NJ-Y001 (HMO D-SNP) plan provides robust medical coverage with many essential services featuring no copays. Inpatient hospital stays require a $1,735 copay per stay with no coinsurance, while primary care, specialist visits, and outpatient services feature no copays and coinsurance ranging from 0% to 20%. Emergency room visits have a $115 copay that is waived upon admission, and urgent care is available with a copay of up to $40 or no copay. For additional care, home health services, skilled nursing facility stays, and diagnostic radiology are covered with no copay and no coinsurance. Diagnostic hearing and vision services are also available with no copays, deductibles, or coinsurance, though routine dental, vision, and hearing exams are not covered under this plan. Furthermore, members benefit from over-the-counter items and meals for chronic illnesses with no copay and no coinsurance, while dialysis and durable medical equipment require no copay and a 20% coinsurance.
Inpatient Hospital See details
UHC Dual Complete NJ-Y001 (HMO D-SNP) provides partially covered inpatient hospital services with a $1,735 copay per stay and no coinsurance for both acute and psychiatric care. While unlimited additional acute care days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
UHC Dual Complete NJ-Y001 (HMO D-SNP) covers outpatient services with no copays, though coinsurance ranging from no coinsurance up to 20% and prior authorization requirements apply to outpatient hospital, ambulatory surgical center, and substance abuse services. Outpatient blood services are also covered with no copay, a 20% coinsurance, and no deductible, with the deductible waived for the first three pints of blood.
Partial Hospitalization See details
UHC Dual Complete NJ-Y001 (HMO D-SNP) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance services are covered by UHC Dual Complete NJ-Y001 (HMO D-SNP) with a 20% coinsurance and no copay for both ground and air transportation, subject to prior authorization, while routine transportation services are not covered.
Emergency Services See details
Emergency services are covered under the UHC Dual Complete NJ-Y001 (HMO D-SNP) plan with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $0 to $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are provided with no copay and no coinsurance.
Primary Care See details
UHC Dual Complete NJ-Y001 (HMO D-SNP) covers primary care, specialist, and mental health services with no copays and coinsurance ranging from 0% to 20%, while telehealth and opioid treatment services feature no copay and no coinsurance. Therapy services require no copay and a 20% coinsurance, but podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by UHC Dual Complete NJ-Y001 (HMO D-SNP), featuring no copayments or coinsurance for annual physicals, kidney disease education, fitness benefits, weight management, and home safety devices, while digital rectal exams and post-welcome-visit EKGs require a 20% coinsurance. Uncovered sub-services include health education, in-home safety assessments, 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 tobacco cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
UHC Dual Complete NJ-Y001 (HMO D-SNP) partially covers hearing services, providing diagnostic hearing exams with no copay, no coinsurance, and no deductible, though prior authorization is required. Routine hearing exams, fitting and evaluation services, prescription hearing aids, and OTC hearing aids are not covered under this plan.
Vision Services See details
Vision Services are covered by UHC Dual Complete NJ-Y001 (HMO D-SNP) with no copay, no deductible, and no coinsurance. Although some services are covered, in practice routine eye exams, other eye exams, contact lenses, eyeglasses, and upgrades are not covered.
Dental Services See details
UHC Dual Complete NJ-Y001 (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance, subject to prior authorization. However, other dental services are not covered, including oral exams, cleanings, x-rays, fluoride treatments, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
UHC Dual Complete NJ-Y001 (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete NJ-Y001 (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is covered by UHC Dual Complete NJ-Y001 (HMO D-SNP) with no copays for durable medical equipment (DME), prosthetics, and diabetic supplies. A 20% coinsurance applies to DME, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete NJ-Y001 (HMO D-SNP) with prior authorization required. Diagnostic procedures and tests require a copay and 20% coinsurance, while lab services have no copay. Radiological services have no copays, featuring no coinsurance for diagnostic radiology and 20% coinsurance for therapeutic radiology and outpatient X-rays.
Home Health Services See details
UHC Dual Complete NJ-Y001 (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
UHC Dual Complete NJ-Y001 (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay, though only some services are covered. Specifically, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UHC Dual Complete NJ-Y001 (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, although the plan does allow admission with less than a three-day prior inpatient hospital stay.
Other Services See details
Other services are partially covered by UHC Dual Complete NJ-Y001 (HMO D-SNP), which offers over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance, while acupuncture is not covered.
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