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UHC Dual Complete WA-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 WA-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 WA-S4 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete WA-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 King, Pierce, and Snohomish counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that UHC Dual Complete WA-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 WA-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 WA-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 WA-S4 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.20. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.20. 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 $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 WA-S4 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs according to the plan's formulary. Once your total drug costs reach $2000, you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your Part D premium is $26.20. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete WA-S4 (HMO-POS D-SNP) plan provides coverage for a range of services, including inpatient hospital stays with a $1425 copay per admission, outpatient services with varying coinsurance, and emergency services with a $110 copay. Primary care, preventive services, and home health services are covered with no copay, while other services like hearing, vision, and dental have specific copays, coinsurance, or annual limits. The plan also offers additional benefits such as over-the-counter items, acupuncture, and a meal benefit for chronic illness, with varying cost-sharing arrangements.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you will pay a copay of $1425.00 per admission or stay, and for Additional Days (91-999), there is no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, along with Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including 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% to 20%, observation services have a 20% coinsurance, ambulatory surgical center services have a coinsurance of 0% to 20%, individual sessions for outpatient substance abuse have a coinsurance of 0% to 20%, group sessions for outpatient substance abuse have a 20% coinsurance, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization benefits are covered, but require prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services, and no copay for transportation services to a plan-approved health-related location, which includes up to 36 one-way trips per year via taxi or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the UHC Dual Complete WA-S4 (HMO-POS D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The UHC Dual Complete WA-S4 (HMO-POS D-SNP) plan covers primary care physician services with a coinsurance between 0% and 20%, chiropractic services with a 20% coinsurance, occupational therapy services with a coinsurance between 0% and 20%, physician specialist services with a coinsurance between 0% and 20%, and mental health specialty services with a coinsurance that varies based on the type of service. The plan also covers podiatry services with a 20% coinsurance for routine foot care, other health care professional services with a coinsurance between 0% and 20%, psychiatric services with a coinsurance that varies based on the type of service, physical therapy and speech-language pathology services with a coinsurance between 0% and 20%, additional telehealth benefits with no copay, and opioid treatment program services with no copay. Routine chiropractic care has no copay, but is limited to 12 visits per year.
Preventive Services See details
Preventive Services include annual physical exams with no copay, and other preventive services, such as glaucoma screenings, diabetes self-management training, and barium enemas, with no copay. Digital rectal exams and EKGs following a Welcome Visit have a 20% coinsurance.
Hearing Services See details
The UHC Dual Complete WA-S4 (HMO-POS D-SNP) plan covers hearing exams with at most 20% coinsurance and fitting/evaluation for hearing aids is not covered. Prescription hearing aids are covered with no copay, and OTC hearing aids are covered with no copay.
Vision Services See details
The UHC Dual Complete WA-S4 (HMO-POS D-SNP) plan covers vision services including eye exams and eyewear, with no copay for routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames. Eyeglasses (lenses and frames) and upgrades are not covered. Contact lenses, eyeglass lenses, and eyeglass frames are limited to one per year. There is a combined maximum of $350 every year for eyewear.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, and other dental services with a maximum plan benefit of $2,500 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, and maxillofacial prosthetics have no copay. Orthodontic and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete WA-S4 (HMO-POS D-SNP) plan, but require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 15% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 15% coinsurance, while Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 15% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%. Lab Services have no copay.
Home Health Services See details
Home Health Services are covered by UHC Dual Complete WA-S4 (HMO-POS D-SNP) 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 none of the listed sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization is required for the Cardiac Rehabilitation Services benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. This plan requires prior authorization for SNF services and charges the Medicare-defined cost share for tier 1.
Other Services See details
The UHC Dual Complete WA-S4 (HMO-POS D-SNP) plan covers acupuncture with no copay, up to 12 treatments per year. Over-the-counter items are covered with no copay, including nicotine replacement therapy and naloxone, though not all drugs on the CMS OTC list are covered. The plan also offers a meal benefit for chronic illness with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment 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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