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UHC Dual Complete WI-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 WI-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 WI-D003 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete WI-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 Select Counties in Wisconsin. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete WI-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 WI-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 WI-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 WI-D003 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.10. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.60. 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 WI-D003 (HMO-POS D-SNP) plan has a $590.00 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. If you qualify for the low-income subsidy (LIS), the plan's premium is $38.10. Once your yearly out-of-pocket drug costs reach $2000.00, you will enter the catastrophic coverage phase, where you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete WI-D003 (HMO-POS D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $2,000 copay, while emergency services have a $110 copay, and outpatient services have coinsurance between 0% and 20%. Many services have no copay, including preventive services, routine hearing exams, eye exams, eyewear, and many dental services. This plan also includes coverage for ambulance and transportation services, with a 20% coinsurance for ground and air ambulance. Vision and dental benefits are included with no copays for many services, but some services require coinsurance. The plan also covers home health services and dialysis services with no copay or coinsurance in some cases.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization and have a $2,000 copay per admission or stay for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute have no copay for days 91-999, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a coinsurance between 0% and 20%, observation services with a 20% coinsurance, and ambulatory surgical center services with a coinsurance between 0% and 20%. Outpatient substance abuse services are covered, with individual sessions having a coinsurance between 0% and 20% and group sessions with a 20% coinsurance. Outpatient blood services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Dual Complete WI-D003 (HMO-POS D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and are limited to 24 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, including Urgently Needed Services and Worldwide Emergency Services, are covered by the UHC Dual Complete WI-D003 (HMO-POS D-SNP) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a copay between $0-$45 and no coinsurance, and Worldwide Emergency Services have a $0 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services (Individual Sessions), Psychiatric Services (Individual Sessions), Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits are covered with a coinsurance of 0% to 20%. Chiropractic Services are covered with 20% coinsurance, and Routine Foot Care has 20% coinsurance. Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services that may have a copay. This plan also covers glaucoma screenings, diabetes self-management training, and barium enemas with no copay, and digital rectal exams and EKG following Welcome Visit with 20% coinsurance.
Hearing Services See details
Hearing services include coverage for routine hearing exams with no copay and a 20% coinsurance, and prescription hearing aids with no copay, with a maximum plan benefit of $2200 per year. OTC hearing aids are covered with no copay.
Vision Services See details
The UHC Dual Complete WI-D003 (HMO-POS D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay. Contact lenses and eyeglass lenses and frames are covered, but eyeglass frames and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $2,000 annual maximum benefit. Medicare Dental Services have a 20% coinsurance after prior authorization, and other dental services include oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, and other preventive services with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery are covered with no copay after prior authorization. However, Implant Services and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is 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 WI-D003 (HMO-POS D-SNP) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance. 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 all diagnostic, and radiological services, are covered. Diagnostic Procedures/Tests have a coinsurance of up to 20%, and Lab Services have no copay. Diagnostic Radiological Services have a coinsurance of up to 20% with a minimum of 0%, while Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of up to 20% with a minimum of 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete WI-D003 (HMO-POS D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the specific services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the UHC Dual Complete WI-D003 (HMO-POS D-SNP) plan, but the plan does not cover additional days beyond Medicare-covered for SNF or non-Medicare-covered stays. Prior authorization is required for this benefit, and the copay is determined by Medicare-defined cost sharing.
Other Services See details
The UHC Dual Complete WI-D003 (HMO-POS D-SNP) plan's other services include over-the-counter items with no copay, and a meal benefit with no copay, but requires prior authorization. Acupuncture, 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, 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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