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UHC Complete Care NY-31 (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Complete Care NY-31 (HMO-POS C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Complete Care NY-31 (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
UHC Complete Care NY-31 (HMO-POS C-SNP) is a HMO-POS C-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Select Counties in New York. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that UHC Complete Care NY-31 (HMO-POS C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
UHC Complete Care NY-31 (HMO-POS C-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 Complete Care NY-31 (HMO-POS C-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 Complete Care NY-31 (HMO-POS C-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 $520.00 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 $8300.00 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 Complete Care NY-31 (HMO-POS C-SNP) prescription drug plan features an annual drug deductible of $520. Tier 1 preferred generic drugs are highly affordable, requiring no copay for standard pharmacy fills or 3-month mail orders. Tier 2 generic drugs carry a $12 copay for a 1-month supply at standard pharmacies, but you can receive a 3-month supply with no copay when using preferred mail order. For brand name and specialty medications, your costs are determined by coinsurance. Tier 3 preferred brand drugs require an 18% coinsurance for both 1-month and 3-month supplies. Tier 4 non-preferred drugs carry a 42% coinsurance, while Tier 5 specialty tier drugs carry a 27% coinsurance for a 1-month supply.
Additional Benefits
The UHC Complete Care NY-31 (HMO-POS C-SNP) plan offers robust coverage with no copay and no coinsurance for primary care, telehealth, and routine preventive services. For inpatient hospital stays, members pay a 455 dollar daily copay for the first five days and no copay for subsequent days. Emergency room visits carry a 115 dollar copay, which is waived if you are admitted within 24 hours. Routine dental care, annual eye exams, and hearing tests are fully covered with no copay and no coinsurance. Additionally, home health services, diabetic supplies, and over-the-counter items are available with no copay. For other essential needs like durable medical equipment and dialysis, the plan features no copay and a 20 percent coinsurance.
Inpatient Hospital See details
UHC Complete Care NY-31 (HMO-POS C-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $455 copay for days 1 through 5 and no copay for days 6 and beyond, while psychiatric stays require a $455 copay for days 1 through 4 and no copay for days 5 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
UHC Complete Care NY-31 (HMO-POS C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $455 copay for outpatient hospital services and a $455 daily copay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services carry a $0 to $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the UHC Complete Care NY-31 (HMO-POS C-SNP) plan with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UHC Complete Care NY-31 (HMO-POS C-SNP) with a $270 copay and no coinsurance for ground and air ambulance services, which require prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
UHC Complete Care NY-31 (HMO-POS C-SNP) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services are available with a copay of $0 to $40 and no coinsurance, while worldwide emergency, urgent, and transportation services are fully covered with no copay and no coinsurance.
Primary Care See details
UHC Complete Care NY-31 (HMO-POS C-SNP) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $40 copay and no coinsurance. Physical, occupational, and speech therapies are covered with copays ranging from $35 to $40 and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by UHC Complete Care NY-31 (HMO-POS C-SNP) with no copay and no coinsurance for covered care, such as annual physical exams, fitness benefits, and diabetes self-management. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and in-home support.
Hearing Services See details
Hearing services are partially covered by UHC Complete Care NY-31 (HMO-POS C-SNP), featuring one routine annual hearing exam with no copay or coinsurance, though fitting and evaluation exams are not covered. The plan also covers up to two OTC hearing aids (with a $199 to $829 copay) and two prescription hearing aids (with a $199 to $1,249 copay) per year with no coinsurance, but inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by UHC Complete Care NY-31 (HMO-POS C-SNP) with no deductible and no coinsurance for covered services. Routine eye exams, contact lenses, and eyeglass frames feature no copay, while eyeglass lenses have a copay of $0 to $153 up to a $150 eyewear maximum every two years, but other eye exams, upgrades, and packaged eyeglasses are not covered.
Dental Services See details
UHC Complete Care NY-31 (HMO-POS C-SNP) partially covers dental services, offering preventive and diagnostic care with no copay and no coinsurance, alongside Medicare-covered dental services with no copay and a 20% coinsurance. However, several major services are not covered, including restorative treatments, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
UHC Complete Care NY-31 (HMO-POS C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is 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 by UHC Complete Care NY-31 (HMO-POS C-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
UHC Complete Care NY-31 (HMO-POS C-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are also covered with no copay and no coinsurance, though prior authorization is required and manufacturer limitations apply.
Diagnostic and Radiological Services See details
UHC Complete Care NY-31 (HMO-POS C-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures and tests require a $45 copay and no coinsurance, lab services and diagnostic radiological services have no copay or coinsurance, outpatient X-rays require a $25 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by the UHC Complete Care NY-31 (HMO-POS C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by UHC Complete Care NY-31 (HMO-POS C-SNP) with no copay and no coinsurance, but prior authorization is required and only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by UHC Complete Care NY-31 (HMO-POS C-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay no copay for days 1 through 20, and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
UHC Complete Care NY-31 (HMO-POS C-SNP) other services are partially covered, featuring over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other miscellaneous services are not covered under this benefit.
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