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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 2025, 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 2025.
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 $56.90. 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 Maximum Out-Of-Pocket cost of $9350.00 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) plan has a deductible of $590.00. Once you meet your deductible, you'll pay the costs for your drugs based on the tier and pharmacy you use. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete NJ-Y001 (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1465 copay per admission, while outpatient services and ambulance services have coinsurance between 0% and 20%. Emergency services have a $110 copay, and primary care, vision, and dental services are covered with no copay. Preventive services, home health services, and diagnostic lab services have no copay, and other services like over-the-counter items and a meal benefit also have no copay. This plan provides coverage for many healthcare needs, but some services, like additional days for inpatient hospital stays, and cardiac rehabilitation services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which have a copay of $1465 per admission or stay for Medicare-covered stays; Additional Days for Inpatient Hospital-Acute has no copay for days 91-999, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a coinsurance of 0% - 20%, observation services with a 20% coinsurance, ambulatory surgical center (ASC) services with a coinsurance between 0% - 20%, individual and group sessions for outpatient substance abuse with a coinsurance between 0% - 20%, and outpatient blood services with a 20% coinsurance. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered under the UHC Dual Complete NJ-Y001 (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the UHC Dual Complete NJ-Y001 (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and there is 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 NJ-Y001 (HMO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45; Worldwide Emergency, Urgent, and Transportation services have no copay.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits are covered. Primary Care Physician Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services have a coinsurance between 0% and 20%, while Occupational Therapy Services has a coinsurance between 0% and 20%, and a $0 copay. Mental Health Specialty Services and Psychiatric Services have coinsurance between 0% and 20%, and Other Health Care Professional have coinsurance between 0% and 20%. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have no copay. However, Chiropractic Services, and Podiatry Services are partially covered, with Routine Chiropractic Care not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and other preventive services. Other preventive services include a 20% coinsurance for EKG following Welcome Visit and Digital Rectal Exams, and no copay for Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas.
Hearing Services See details
Hearing services are partially covered by the UHC Dual Complete NJ-Y001 (HMO D-SNP) plan, with a coinsurance of at most 20% for hearing exams. Routine hearing exams, fitting/evaluation for hearing aids, and all types of prescription hearing aids are not covered, nor are OTC hearing aids.
Vision Services See details
Vision Services include eye exams with no copay, but routine eye exams are not covered. Eyewear has no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, 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 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment includes Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic and radiological services, are covered. 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 NJ-Y001 (HMO 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 NJ-Y001 (HMO D-SNP) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and the copay is based on the Medicare-defined cost share for tier 1.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items and a Meal Benefit, both with no copay, while Acupuncture, 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 are not covered.
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