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UHC Complete Care OR-5 (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Complete Care OR-5 (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 OR-5 (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
UHC Complete Care OR-5 (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 Oregon. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that UHC Complete Care OR-5 (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 OR-5 (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 OR-5 (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 OR-5 (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 $255.00 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 $4500.00 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 OR-5 (HMO-POS C-SNP) plan has a $255.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, in the initial coverage phase, the copay is $12.00 for preferred generic drugs at a standard pharmacy and $47.00 for standard generic drugs at a standard pharmacy. For preferred brand drugs, the copay is $100.00. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Complete Care OR-5 (HMO-POS C-SNP) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and coverage for ambulance and emergency services. The plan also covers primary care, preventive, hearing, vision, and dental services, often with no copay for many services. Additional benefits include home health services, skilled nursing facility care, and coverage for medical equipment like Durable Medical Equipment and diabetic supplies. Some services, like cardiac rehabilitation and certain dental and vision upgrades, are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Acute and Psychiatric services. For the first 4 days of an inpatient hospital stay, there is a $400 copay, and then no copay for days 5-90. Additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $400, observation services with a $400 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Complete Care OR-5 (HMO-POS C-SNP) 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 Complete Care OR-5 (HMO-POS C-SNP) plan. Ground and air ambulance services each have a copay of $275, with no coinsurance, but 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 by the UHC Complete Care OR-5 (HMO-POS C-SNP) plan. Emergency Services has a $125 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $55, and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have no copay and no coinsurance.
Primary Care See details
The UHC Complete Care OR-5 (HMO-POS C-SNP) plan covers primary care services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a copay between $0 and $20. The plan also covers physician specialist services with a copay between $0 and $25, and mental health specialty services with a copay between $0 and $25 for individual sessions, and a $15 copay for group sessions. Podiatry services and other health care professional services have a copay between $25, and $0 and $25, respectively, and psychiatric services have a copay between $0 and $25 for individual sessions, and a $15 copay for group sessions. Physical therapy and speech-language pathology services have a copay between $0 and $20, and 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, Annual Physical Exams with no copay, and additional preventive services with varying copays. Some preventive services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are covered once per year with no copay. Prescription hearing aids (all types) are covered with a copay between $199 and $1249, with a limit of two per year, while OTC hearing aids are covered with a copay between $99 and $829. Fitting/evaluation for hearing aids, and prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The UHC Complete Care OR-5 (HMO-POS C-SNP) plan covers vision services, including eye exams with no copay. Eyewear is covered, with no copay for contact lenses, eyeglass frames, and eyeglass lenses, although eyeglass lenses may have a copay between $0.00 and $153.00. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are partially covered under the UHC Complete Care OR-5 (HMO-POS C-SNP) plan. Medicare Dental Services have a 20% coinsurance and require prior authorization, while Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services have no copay. 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, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Complete Care OR-5 (HMO-POS C-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies has no copay and 20% coinsurance for Medicare-covered devices and supplies, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a $45 copay, and lab services with no copay. Radiological services include diagnostic services with a copay of at most $250, therapeutic services with a coinsurance of at most 20%, and outpatient X-ray services with a $15 copay.
Home Health Services See details
Home Health Services are covered by the UHC Complete Care OR-5 (HMO-POS C-SNP) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the UHC Complete Care OR-5 (HMO-POS C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Complete Care OR-5 (HMO-POS C-SNP) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $203.
Other Services See details
Under the UHC Complete Care OR-5 (HMO-POS C-SNP) plan, Over-the-Counter (OTC) Items and Meal Benefits are covered 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. OTC items include Nicotine Replacement Therapy (NRT) and Naloxone coverage.
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