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UHC Dual Complete TX-D003 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete TX-D003 (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 TX-D003 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete TX-D003 (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 Cameron, Hidalgo, and Willacy counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that UHC Dual Complete TX-D003 (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 TX-D003 (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 TX-D003 (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 TX-D003 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $3.30. 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 TX-D003 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your prescriptions, until your total drug costs reach $2000. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you will pay $3.30 for your prescriptions.
Additional Benefits
The UHC Dual Complete TX-D003 (HMO-POS D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance amounts. You'll have a $2,000 copay for inpatient hospital stays, and 0-20% coinsurance for outpatient services. The plan provides no copay for hearing aids, eyewear, dental services, home health, and various preventive services. The plan also covers emergency services with a copay, and offers transportation services with no copay for up to 48 one-way trips per year. Additionally, you'll have access to dental, vision, and hearing services. The plan offers additional coverage such as no copay for diabetic supplies, and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization and a doctor referral. For Inpatient Hospital-Acute, there is a $2,000 copay per admission or stay, and additional days from days 91-999 have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a coinsurance of 0% - 20%, observation services have a 20% coinsurance, and outpatient blood services have a 20% coinsurance. Individual sessions for outpatient substance abuse have a 0% - 20% coinsurance, and group sessions for outpatient substance abuse have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete TX-D003 (HMO-POS D-SNP) plan, but requires prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
The UHC Dual Complete TX-D003 (HMO-POS D-SNP) plan covers ambulance services with a 20% coinsurance for both ground and air ambulance services, and transportation services with no copay, including transportation to plan-approved health-related locations for up to 48 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the UHC Dual Complete TX-D003 (HMO-POS D-SNP) plan, with a $110 copay and no coinsurance. Urgently Needed Services have a copay ranging from $0 to $45, with no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are covered with no coinsurance and no copay.
Primary Care See details
The UHC Dual Complete TX-D003 (HMO-POS D-SNP) plan covers primary care services with a coinsurance of 0% to 20%. Chiropractic services are partially covered, but routine care is not covered, with a 20% coinsurance. Additional telehealth benefits are covered with no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional services. The plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 (including Web/Phone-based technologies and Nursing Hotline), or Counseling Services. Other covered services include Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, and Home and Bathroom Safety Devices and Modifications, all with no copay. Digital Rectal Exams and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, while fitting/evaluation for hearing aids is not covered. Prescription hearing aids are covered with no copay and a maximum benefit of $1500 per year, and OTC hearing aids are covered with no copay.
Vision Services See details
The UHC Dual Complete TX-D003 (HMO-POS D-SNP) plan covers vision services, including routine eye exams and eyewear. There is no copay for eye exams, and no copay for eyewear. Contact lenses, eyeglass lenses, and eyeglass frames are covered, but eyeglass frames are limited to one per year, and eyeglass lenses are limited to one pair per year.
Dental Services See details
Dental services are covered. Medicare Dental Services have a 20% coinsurance, while other services have a maximum plan benefit of $1500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery are covered with no copay. However, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and may require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and between 0% and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the UHC Dual Complete TX-D003 (HMO-POS D-SNP) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
The UHC Dual Complete TX-D003 (HMO-POS D-SNP) plan covers Durable Medical Equipment (DME) with 20% coinsurance and requires prior authorization, but does not cover DME for use outside the home. Prosthetics/Medical Supplies are covered with a 20% coinsurance, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic procedures/tests and therapeutic radiological services have a coinsurance of at most 20%, while lab services have no copay. Diagnostic radiological services have a coinsurance of at most 20% 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 TX-D003 (HMO-POS D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the UHC Dual Complete TX-D003 (HMO-POS D-SNP) plan, but the plan does not cover any of the specific Cardiac Rehabilitation Services. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. A doctor referral and prior authorization are required, and the plan charges the Medicare-defined cost share for tier 1.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, but acupuncture, meal benefits, 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. This plan also offers Nicotine Replacement Therapy (NRT) and Naloxone coverage as a Part C OTC benefit.
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