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UHC Complete Care WA-13 (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Complete Care WA-13 (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 WA-13 (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
UHC Complete Care WA-13 (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 Washington. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that UHC Complete Care WA-13 (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 WA-13 (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 WA-13 (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 WA-13 (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 $355.00 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 $5900.00 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:
Sign up for UHC Complete Care WA-13 (HMO-POS C-SNP)
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Drug Coverage
The UHC Complete Care WA-13 (HMO-POS C-SNP) prescription drug plan features an annual drug deductible of $355. Tier 1 preferred generic drugs are highly accessible, offering no copay for standard pharmacy fills and three-month mail orders. Tier 2 generic medications cost a $10 copay for a one-month supply at standard pharmacies, though you can secure a three-month supply with no copay through preferred mail order. For higher-tier prescriptions, coverage transitions from flat copays to coinsurance. Tier 3 preferred brand drugs require a 21% coinsurance for standard pharmacy and mail-order fills. Tier 4 non-preferred drugs carry a 40% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a one-month supply.
Additional Benefits
The UHC Complete Care WA-13 (HMO-POS C-SNP) plan offers comprehensive medical coverage with predictable costs, featuring no copay or coinsurance for primary care visits and routine preventive services. For specialized medical needs, specialist visits range from no copay to a $35 copay, while inpatient hospital stays require a $450 daily copay for the first five days and no copay for days six and beyond. Emergency care carries a $130 copay, which is waived upon hospital admission, while urgent care ranges from no copay to a $50 copay. Routine vision exams, annual hearing tests, and preventive dental care are highly accessible with no copays or coinsurance. For medical hardware, durable medical equipment and dialysis services require a 20% coinsurance with no copay, whereas diabetic supplies and home health services are available with no copay. Skilled nursing facility care is also covered with no copay for the first 20 days, transitioning to a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
UHC Complete Care WA-13 (HMO-POS C-SNP) covers inpatient hospital services with no coinsurance, requiring a $450 daily copay for days 1 to 5 and no copay for days 6 and beyond. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by UHC Complete Care WA-13 (HMO-POS C-SNP) with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $0 to $25 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, though prior authorization is required for most of these services.
Partial Hospitalization See details
Partial hospitalization is covered by UHC Complete Care WA-13 (HMO-POS C-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UHC Complete Care WA-13 (HMO-POS C-SNP), featuring a $290.00 copay and no coinsurance for both ground and air ambulance services, which require prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
UHC Complete Care WA-13 (HMO-POS C-SNP) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay of $0 to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copays and no coinsurance.
Primary Care See details
UHC Complete Care WA-13 (HMO-POS C-SNP) offers primary care and telehealth services with no copay and no coinsurance, while specialists and other health professionals range from a $0 to $35 copay with no coinsurance. Therapy services and podiatry require a $35 copay with no coinsurance, mental health sessions range from a $0 to $25 copay with no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by UHC Complete Care WA-13 (HMO-POS C-SNP) with no copay and no coinsurance for annual physicals, kidney disease education, fitness benefits, and safety devices. This benefit is partially covered, as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by UHC Complete Care WA-13 (HMO-POS C-SNP) with no deductible and no coinsurance. You will pay no copay for one routine hearing exam per year, but fitting and evaluation exams are not covered; prescription hearing aids (copays of $199 to $1,249) and OTC hearing aids (copays of $199 to $829) are covered up to two devices per year, though inner ear, outer ear, and over the ear prescription models are excluded.
Vision Services See details
Vision services are partially covered by UHC Complete Care WA-13 (HMO-POS C-SNP) with no coinsurance and no copay for annual routine eye exams, contact lenses, and eyeglass frames, though other eye exam services, upgrades, and packaged eyeglasses are not covered. Eyeglass lenses are covered with a copay of $0.00 to $153.00, and a combined maximum benefit of $150.00 applies to eyewear every two years.
Dental Services See details
Dental services are partially covered by UHC Complete Care WA-13 (HMO-POS C-SNP), featuring no copay and no coinsurance for preventive care like exams and cleanings, and no copay with a 20% coinsurance for Medicare-covered dental. However, several sub-services are not covered, including restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Complete Care WA-13 (HMO-POS C-SNP) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs feature no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the UHC Complete Care WA-13 (HMO-POS C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
UHC Complete Care WA-13 (HMO-POS C-SNP) covers medical equipment, with prior authorization required for services. Durable medical equipment and prosthetics or medical supplies feature no copay and 20% coinsurance, while diabetic equipment and supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
UHC Complete Care WA-13 (HMO-POS C-SNP) covers diagnostic and radiological services, requiring prior authorization for all care. Diagnostic tests require a $50 copay with no coinsurance, lab services have no copay, outpatient X-rays require a $25 copay, and therapeutic radiology has a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by UHC Complete Care WA-13 (HMO-POS C-SNP) 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 WA-13 (HMO-POS C-SNP) with no copay and no coinsurance, although some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by UHC Complete Care WA-13 (HMO-POS C-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
UHC Complete Care WA-13 (HMO-POS C-SNP) provides partially covered other services, which include over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, although meals require prior authorization. Acupuncture is not covered under this plan benefit.
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