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UHC Dual Complete NY-S4 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete NY-S4 (HMO-POS 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 NY-S4 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete NY-S4 (HMO-POS D-SNP) is a HMO-POS D-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 2025.
It's important to know that UHC Dual Complete NY-S4 (HMO-POS 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 NY-S4 (HMO-POS 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 NY-S4 (HMO-POS 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 NY-S4 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $37.50. 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 $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 NY-S4 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on the drug tier and pharmacy type until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), you may have a reduced premium of $37.50. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The UHC Dual Complete NY-S4 (HMO-POS D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $2,000 copay, while outpatient services, including substance abuse treatment, typically have a coinsurance between 0% and 20%. Emergency services have a $110 copay, and transportation to plan-approved health-related locations is covered with no copay for up to 36 one-way trips per year. Preventive services, including annual physical exams, and many other services like vision and dental have no copays. Hearing aids are covered with no copay, and a maximum benefit of $2200 per year. The plan also covers home health services with no copay, and offers coverage for various other services, including medical equipment, diagnostic services, and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $2,000 copay for a Medicare-covered stay, and no copay for days 91-999. Inpatient Hospital Psychiatric benefits are also covered, with a $2,000 copay for a Medicare-covered stay, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a coinsurance between 0% and 20%, observation services with a 20% coinsurance, and ambulatory surgical center services with a coinsurance between 0% and 20%. Outpatient substance abuse services include individual sessions with a coinsurance between 0% and 20%, and group sessions with a 20% coinsurance. Outpatient blood services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay. 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. Transportation Services to a plan-approved health-related location are covered with no copay, for up to 36 one-way trips per year via taxi or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the UHC Dual Complete NY-S4 (HMO-POS D-SNP) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a copay between $0 and $45, with no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The UHC Dual Complete NY-S4 (HMO-POS D-SNP) plan covers primary care, chiropractic, occupational therapy, physician specialist, mental health specialty, podiatry, other health care professional, psychiatric, physical therapy, speech-language pathology, additional telehealth, and opioid treatment program services. Individual and group mental health and psychiatric sessions, as well as routine foot care, have a coinsurance of 20%, while other services have a coinsurance between 0% and 20%; additionally, routine foot care has a copay. Additional telehealth benefits have no copay.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, and annual physical exams with no copay. Additional preventive services, kidney disease education services, glaucoma screenings, diabetes self-management training, and barium enemas have no copay. Digital rectal exams and EKG following a welcome visit have a 20% coinsurance. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services.
Hearing Services See details
Hearing services include hearing exams with a coinsurance of at most 20% for routine hearing exams, and prescription hearing aids with no copay and a maximum benefit of $2200 per year for all types, while OTC hearing aids have no copay. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision Services includes eye exams and eyewear. Eye exams have no copay, including routine eye exams. Eyewear has no copay, and includes contact lenses, eyeglass lenses, and eyeglass frames, but excludes eyeglasses (lenses and frames), and upgrades.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, and other preventive services have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance; Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the UHC Dual Complete NY-S4 (HMO-POS D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay, 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 NY-S4 (HMO-POS D-SNP) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the UHC Dual Complete NY-S4 (HMO-POS D-SNP) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered for SNF or non-Medicare-covered stays for SNF. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
The UHC Dual Complete NY-S4 (HMO-POS D-SNP) plan's "Other Services" benefit covers over-the-counter items and meal benefits with no copay, but acupuncture and several other services are not covered. Over-the-counter items include nicotine replacement therapy and naloxone.
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