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UHC Complete Care TX-16 (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Complete Care TX-16 (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 TX-16 (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
UHC Complete Care TX-16 (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 Texas. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that UHC Complete Care TX-16 (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 TX-16 (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 TX-16 (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 TX-16 (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 $340.00 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 $5400.00 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 TX-16 (HMO-POS C-SNP) plan has a $340 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard pharmacy. For standard generic drugs at a standard pharmacy, the copay is $47. The copay for preferred brand drugs is $100. Non-preferred drugs have a 29% coinsurance. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase.
Additional Benefits
The UHC Complete Care TX-16 (HMO-POS C-SNP) plan offers a variety of benefits, including inpatient and outpatient hospital services with copays ranging from $0 to $260, and no copays for many preventive services. The plan also covers ambulance and transportation services, emergency services, and primary care with no copay for many services. Additional benefits include hearing, vision, and dental services, with varying copays and coinsurance. The plan also covers home health services, and skilled nursing facility services. The plan does not cover a number of other services, including some services related to cardiac rehabilitation, private duty nursing, and orthodontics.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $260 copay for days 1-5, and no copay for days 6-90, and no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $260 copay for days 1-5, and no copay for days 6-90, and no coinsurance. Additional Days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services are covered. Outpatient Hospital Services have a copay ranging from $0 to $260, Observation Services have a $260 copay, Ambulatory Surgical Center (ASC) Services have no copay, Individual Sessions for Outpatient Substance Abuse have a copay between $0 and $25, Group Sessions for Outpatient Substance Abuse have a $15 copay, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with no copay, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Complete Care TX-16 (HMO-POS C-SNP) plan, including both ground and air ambulance services with a $275 copay. Transportation Services to a plan-approved health-related location are covered with no copay, up to 12 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 by the UHC Complete Care TX-16 (HMO-POS C-SNP) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $55. Worldwide Emergency Services has no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a copay between $0 and $25, while Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services have a copay between $0 and $25. Mental Health Specialty Services and Psychiatric Services have a copay between $0 and $25 for individual sessions, and a $15 copay for group sessions. Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive services are covered by the UHC Complete Care TX-16 (HMO-POS C-SNP) plan. Medicare-covered preventive services, annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have no copay. Other preventive services, including fitness benefits and home and bathroom safety devices and modifications, are also covered with no copay.
Hearing Services See details
Hearing services include hearing exams with no copay, routine hearing exams with no copay, and OTC hearing aids with a copay of $99 - $829. Prescription hearing aids are partially covered, but do not cover inner ear, outer ear, or over the ear hearing aids.
Vision Services See details
The UHC Complete Care TX-16 (HMO-POS C-SNP) plan covers vision services, including routine eye exams with no copay, and eyewear with no copay for contact lenses, eyeglass frames, and eyeglass lenses with a copay between $0.00 - $153.00. This plan has a combined maximum benefit of $200.00 for eyewear every two years, but does not cover eyeglasses (lenses and frames) or upgrades.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery are covered with no copay, and Prosthodontics, removable and Prosthodontics, fixed are covered with 0% - 50% coinsurance; however, Implant Services and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%. Other Medicare Part B drugs, and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the UHC Complete Care TX-16 (HMO-POS C-SNP) plan, but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME) with 20% coinsurance and prior authorization required, and prosthetic devices and medical supplies with 20% coinsurance; however, durable medical equipment for use outside the home is not covered. Diabetic equipment is covered, including diabetic supplies and diabetic therapeutic shoes/inserts with no copay.
Diagnostic and Radiological Services See details
The UHC Complete Care TX-16 (HMO-POS C-SNP) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a $50 copay, lab services with no copay, diagnostic radiological services with a copay up to $250, therapeutic radiological services with a copay up to $50, and outpatient X-ray services with no copay. Prior authorization and a doctor's referral are required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the UHC Complete Care TX-16 (HMO-POS C-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, but some services are not covered. 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
The UHC Complete Care TX-16 (HMO-POS C-SNP) plan covers Skilled Nursing Facility (SNF) services. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The UHC Complete Care TX-16 (HMO-POS C-SNP) plan covers Over-the-Counter (OTC) Items with no copay, and Meal Benefits with no copay, though prior authorization is required. 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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