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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 2026, 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 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $12.00. 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 $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:
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Drug Coverage
The UHC Complete Care TX-16 (HMO-POS C-SNP) plan features an annual prescription drug deductible of $355. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs. This cost savings applies to both one-month and three-month supplies filled at standard retail pharmacies or through standard mail order. For higher-tier medications, your costs will be based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance for both one-month and three-month supplies at standard pharmacies and mail order. Tier 4 non-preferred drugs carry a 45% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance, both for a one-month supply.
Additional Benefits
The UHC Complete Care TX-16 (HMO-POS C-SNP) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $260 daily copay for days 1 through 5, with no copay for days 6 through 90 and no coinsurance. Emergency room visits require a $130 copay, which is waived if admitted, while specialist visits feature a copay ranging from $0 to $35 with no coinsurance. This plan also includes valuable supplemental benefits, featuring routine vision and hearing exams with no copay, alongside dental care options that require no copay for preventive services. Diagnostic lab tests, over-the-counter items, and chronic illness meals are also covered with no copay. For medical equipment, dialysis, and Medicare Part B drugs, members can expect no copay and up to a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by UHC Complete Care TX-16 (HMO-POS C-SNP) with no coinsurance, requiring a $260 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered as unlimited additional acute care days are included with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by UHC Complete Care TX-16 (HMO-POS C-SNP) feature no coinsurance, with no copay required for ambulatory surgical center and blood services. Medicare-covered outpatient hospital services require a copay of $0 to $260, including a $260 daily copay for observation services, while outpatient substance abuse services have copays ranging from $0 to $25 for individual sessions and a flat $15 copay for group sessions.
Partial Hospitalization See details
UHC Complete Care TX-16 (HMO-POS C-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization and a referral are required to access this covered benefit.
Ambulance and Transportation Services See details
UHC Complete Care TX-16 (HMO-POS C-SNP) covers ground and air ambulance services with a $130 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, but trips to any health-related location are not covered.
Emergency Services See details
UHC Complete Care TX-16 (HMO-POS C-SNP) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services feature a copay ranging from $0 to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
UHC Complete Care TX-16 (HMO-POS C-SNP) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $35 copay with no coinsurance. Physical and occupational therapies require a $10 copay with no coinsurance, and though some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by UHC Complete Care TX-16 (HMO-POS C-SNP) with no copay and no coinsurance for covered options like annual physical exams, fitness benefits, home safety devices, kidney disease education, and glaucoma screenings. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling services.
Hearing Services See details
Hearing services are partially covered by UHC Complete Care TX-16 (HMO-POS C-SNP), including one routine hearing exam annually with no copay and no coinsurance, though fitting and evaluation exams are not covered. Covered prescription hearing aids require a copay of $199.00 to $1,249.00 and no coinsurance for up to two devices per year, excluding inner ear, outer ear, and over the ear types. Up to two OTC hearing aids are also covered annually with a copay of $199.00 to $829.00 and no coinsurance.
Vision Services See details
UHC Complete Care TX-16 (HMO-POS C-SNP) offers partially covered vision services with no coinsurance, including one routine eye exam annually with no copay. Eyewear features a $150 combined maximum benefit every two years with no copay for contacts and frames and a $0 to $153 copay for lenses, though other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
UHC Complete Care TX-16 (HMO-POS C-SNP) partially covers dental services, offering Medicare-covered dental with no copay and a 20% coinsurance, and preventive care with no copay and no coinsurance. However, restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by UHC Complete Care TX-16 (HMO-POS C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, have no coinsurance to 20% coinsurance, while covered Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by UHC Complete Care TX-16 (HMO-POS C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Medical equipment covered by UHC Complete Care TX-16 (HMO-POS C-SNP) includes durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes or inserts are also covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
UHC Complete Care TX-16 (HMO-POS C-SNP) diagnostic and radiological services are covered with no coinsurance, though prior authorization and referrals are required. There is no copay for lab services, a $5 copay for diagnostic tests and outpatient X-rays, a minimum $25 copay for therapeutic radiology, and copays starting at $0 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by UHC Complete Care TX-16 (HMO-POS C-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by UHC Complete Care TX-16 (HMO-POS C-SNP) with no copay and no coinsurance, but require prior authorization and referrals. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
UHC Complete Care TX-16 (HMO-POS C-SNP) covers skilled nursing facility (SNF) services with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by UHC Complete Care TX-16 (HMO-POS C-SNP), with acupuncture being excluded from coverage. Covered benefits include over-the-counter (OTC) items and chronic illness meal benefits, both available with no copay and no coinsurance, though prior authorization is required for the meal benefit.
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