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UHC Dual Complete TX-S4 (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-S4 (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-S4 (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete TX-S4 (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 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 Dual Complete TX-S4 (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-S4 (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-S4 (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-S4 (HMO-POS D-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 $0.30. 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 $257.00 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 $9250.00 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 Dual Complete TX-S4 (HMO-POS D-SNP)
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Drug Coverage
The UHC Dual Complete TX-S4 (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $257. For generic medications, this plan offers excellent cost savings with no copay for Tier 1 preferred generic and Tier 2 generic drugs. This zero-cost sharing applies to both one-month and three-month supplies filled at standard retail pharmacies or through standard mail-order services. For higher-tier medications, members are responsible for a 25% coinsurance instead of a flat copayment. This 25% coinsurance applies to Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs. These rates apply to standard pharmacy and standard mail-order fills during the initial coverage phase.
Additional Benefits
The UHC Dual Complete TX-S4 (HMO-POS D-SNP) plan offers robust healthcare coverage with many services requiring no copays. Inpatient hospital stays require copays starting at $2,080 with no coinsurance, while primary care, specialist visits, and outpatient services feature no copays and coinsurance ranging from 0% to 20%. Emergency care is accessible with a $115 copay, which is waived upon hospital admission, and urgent care is available with no copay or a low copay up to $40. In addition to core medical care, this plan provides excellent routine benefits with no copays and no coinsurance, including comprehensive dental up to a $3,000 annual limit, routine vision care with a $350 eyewear allowance, and prescription hearing aids up to $2,500 every two years. Members also enjoy no copays and no coinsurance for home health care, skilled nursing facilities, over-the-counter items, and up to 48 one-way transportation trips per year. Other essential services, such as durable medical equipment and dialysis, are covered with no copays and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by UHC Dual Complete TX-S4 (HMO-POS D-SNP), featuring a $2,165 copay per stay for acute care and a $2,080 copay per stay for psychiatric care, with no coinsurance required for either. Unlimited additional acute care days are covered with no copay, but upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
UHC Dual Complete TX-S4 (HMO-POS D-SNP) covers outpatient services with no copays, although coinsurance ranging from 0% to 20% applies depending on the service. Prior authorization and referrals are required for most services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services.
Partial Hospitalization See details
UHC Dual Complete TX-S4 (HMO-POS D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and referrals are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UHC Dual Complete TX-S4 (HMO-POS D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance, providing up to 48 one-way trips per year via taxi or medical transport to plan-approved locations, while trips to any health-related location are not covered.
Emergency Services See details
UHC Dual Complete TX-S4 (HMO-POS D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay ranging from no copay to $40 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
UHC Dual Complete TX-S4 (HMO-POS D-SNP) covers primary care, specialist, mental health, and psychiatric services with no copay and 0% to 20% coinsurance, while telehealth and opioid treatment are provided with no copay and no coinsurance. Physical, occupational, and speech therapy are covered with no copay and 20% coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by UHC Dual Complete TX-S4 (HMO-POS D-SNP), with most services like annual physicals and fitness benefits requiring no copay and no coinsurance, while digital rectal exams and post-welcome-visit EKGs require no copay and a 20% coinsurance. Multiple sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, smoking cessation, disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete TX-S4 (HMO-POS D-SNP) with no deductible, featuring routine hearing exams for a 20% coinsurance and no copay. Prescription hearing aids (up to $2,500 every two years) and OTC hearing aids are covered with no copays and no coinsurance, though fitting and evaluation exams, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
UHC Dual Complete TX-S4 (HMO-POS D-SNP) provides partially covered vision services with no copay and no coinsurance, which includes one routine eye exam per year and a $350 annual combined limit for contact lenses, eyeglass lenses, and frames. Other eye exam services, eyeglasses (lenses and frames) packages, and upgrades are not covered under this benefit.
Dental Services See details
Dental services are covered by UHC Dual Complete TX-S4 (HMO-POS D-SNP) with no copay and a 20% coinsurance for Medicare-covered dental services, and no copay and no coinsurance for preventive and comprehensive dental care up to a $3,000 annual maximum. This benefit is partially covered, as implant services and orthodontics are not covered.
Home Infusion bundled Services See details
UHC Dual Complete TX-S4 (HMO-POS D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Enrollees will pay no coinsurance to 20% coinsurance for Medicare Part B chemotherapy and other drugs, while Medicare Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under UHC Dual Complete TX-S4 (HMO-POS D-SNP) with no copay and a 20% coinsurance. Both prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
UHC Dual Complete TX-S4 (HMO-POS D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay and no coinsurance, though they are limited to specified manufacturers and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete TX-S4 (HMO-POS D-SNP) with prior authorization and referral requirements. Diagnostic procedures and tests require a copay and a 20% coinsurance, while lab services have no copay. Diagnostic radiological services feature no copay and no coinsurance, whereas therapeutic radiology and outpatient X-rays require a 20% coinsurance and no copay.
Home Health Services See details
Home Health Services are covered under the UHC Dual Complete TX-S4 (HMO-POS D-SNP) plan with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
UHC Dual Complete TX-S4 (HMO-POS D-SNP) offers some services under Cardiac Rehabilitation Services with no copay, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by UHC Dual Complete TX-S4 (HMO-POS D-SNP) with no copay and no coinsurance, though additional days beyond the Medicare-covered limit are not covered. Prior authorization and a referral are required for this benefit, which does not require a prior three-day inpatient hospital stay.
Other Services See details
Other Services under the UHC Dual Complete TX-S4 (HMO-POS D-SNP) plan are partially covered, featuring Over-the-Counter (OTC) items with no copay and no coinsurance. While this OTC benefit includes Naloxone and Nicotine Replacement Therapy, acupuncture and meal benefits are not covered.
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