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UHC Dual Complete WI-S1 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete WI-S1 (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 WI-S1 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete WI-S1 (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 Wisconsin. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete WI-S1 (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 WI-S1 (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 WI-S1 (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 WI-S1 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.50. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.10. 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 WI-S1 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After you meet your 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 (LIS), the monthly premium for Part D is $43.50. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete WI-S1 (HMO-POS D-SNP) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays and coinsurance. This plan also covers primary care, preventive services, hearing, vision, and dental services, often with no copay. The plan also provides coverage for ambulance, emergency, and transportation services, as well as home health and skilled nursing facility services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a copay of $1745 per admission or stay, and for Additional Days (91-999), there is no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a 0% - 20% coinsurance, observation services with a 20% coinsurance, ambulatory surgical center services with a 0% - 20% coinsurance, outpatient substance abuse services with a 0% - 20% coinsurance for individual sessions and a 20% coinsurance for group sessions, and outpatient blood services with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Dual Complete WI-S1 (HMO-POS D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services to a plan-approved health-related location have no copay and are limited to 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the UHC Dual Complete WI-S1 (HMO-POS D-SNP) plan, with a $110 copay and no coinsurance. Urgently Needed Services have a copay between $0 and $45 with no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are covered with no copay and no coinsurance.
Primary Care See details
Primary Care services, including primary care physician services, are covered with a coinsurance between 0% and 20%. Chiropractic services are covered with a 20% coinsurance, but routine care is not covered. Occupational Therapy Services are covered with a coinsurance between 0% and 20%. Physician Specialist Services are covered with a coinsurance between 0% and 20%. Mental Health Specialty Services, including individual sessions with a coinsurance between 0% and 20%, and group sessions with a 20% coinsurance, are covered. Podiatry Services, including routine foot care with a 20% coinsurance, are covered, and Medicare-covered services have no copay. Other Health Care Professional services are covered with a coinsurance between 0% and 20%. Psychiatric Services, including individual sessions with a coinsurance between 0% and 20%, and group sessions with a 20% coinsurance, are covered. Physical Therapy and Speech-Language Pathology Services are covered with a coinsurance between 0% and 20%. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services and additional preventive services such as an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services may have a copay or coinsurance. Glaucoma screenings, diabetes self-management training, and barium enemas have no copay, while digital rectal exams and EKGs following a Welcome Visit have 20% coinsurance.
Hearing Services See details
Hearing services include routine hearing exams with no copay and at most 20% coinsurance, and prescription hearing aids with no copay. OTC hearing aids are covered with no copay.
Vision Services See details
Vision services include eye exams, routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames with no copay, while eyeglasses (lenses and frames) and upgrades are not covered. Routine eye exams, eyeglass lenses, and eyeglass frames are limited to one per year, and eyewear has a combined maximum plan benefit of $300 every year.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, and other dental services with a maximum benefit of $2,500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay, while restorative services, and other services have no copay. Orthodontic services are covered under diagnostic and preventive dental. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the UHC Dual Complete WI-S1 (HMO-POS D-SNP) plan. Insulin has a $35 copay, with coinsurance between 0% and 20% for Medicare Part B Insulin Drugs, while 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 under the UHC Dual Complete WI-S1 (HMO-POS D-SNP) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a coinsurance of at most 20%, and lab services with no copay. Diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are covered with a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete WI-S1 (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 covered, but not covered in practice. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Dual Complete WI-S1 (HMO-POS D-SNP) plan, but the specific copay details are not provided. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The UHC Dual Complete WI-S1 (HMO-POS D-SNP) plan covers Over-the-Counter (OTC) items with no copay, and a meal benefit with no copay. 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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