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UHC Dual Complete NC-S3 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete NC-S3 (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 NC-S3 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete NC-S3 (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 North Carolina. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete NC-S3 (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 NC-S3 (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 NC-S3 (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 NC-S3 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.20. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.40. 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 combined Maximum Out-Of-Pocket cost of $9350.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9350.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 NC-S3 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. During the initial coverage phase, after the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), with a monthly premium of $51.20.
Additional Benefits
The UHC Dual Complete NC-S3 (HMO-POS D-SNP) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a $1565 copay, while outpatient services and many primary care services have coinsurance between 0% and 20%. Emergency services have a $110 copay, and transportation services are covered with no copay for up to 48 one-way trips per year. This plan includes coverage for preventive services with no copay for an annual physical exam. Hearing and vision services are covered, including routine hearing exams with no copay and prescription hearing aids up to $2200 per year, and eye exams with no copay and eyewear up to $350 per year. Dental services have a 20% coinsurance for Medicare-covered services, and some services like oral exams and cleanings have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, the copay for a Medicare-covered stay is $1565, and additional days for Inpatient Hospital-Acute have no copay; however, Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital Psychiatric, the copay for a Medicare-covered stay is $1565, and Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and individual sessions for outpatient substance abuse have a coinsurance between 0% and 20%, observation services have a 20% coinsurance, group sessions for outpatient substance abuse have a 20% coinsurance, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Dual Complete NC-S3 (HMO-POS D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered with no copay, up to 48 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UHC Dual Complete NC-S3 (HMO-POS D-SNP) plan. Emergency Services have a $110 copay with no coinsurance, Urgently Needed Services have a copay between $0 and $45 with no coinsurance, and Worldwide Emergency Services have no copay or coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary care services, including primary care physician services, are covered with a coinsurance of 0% to 20%. Chiropractic services, including routine care, are partially covered with a 20% coinsurance, and require prior authorization. Occupational therapy services are covered with a coinsurance of 0% to 20%, and require prior authorization. Physician specialist services are covered with a coinsurance of 0% to 20%, and require prior authorization. Mental health services are covered with a coinsurance of 0% to 20%, depending on the service, and require prior authorization. Podiatry services are covered with a 20% coinsurance for routine foot care, and a copay of $0. Other health care professional services are covered with a coinsurance of 0% to 20%, and require prior authorization. Psychiatric services are covered with a coinsurance of 0% to 20%, depending on the service, and require prior authorization. Physical therapy and speech-language pathology services are covered with a coinsurance of 0% to 20%, and require prior authorization. Additional telehealth benefits are covered with no copay. Opioid treatment program services are covered with no copay, and require prior authorization.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional preventive services may have a copay. Other preventive services include glaucoma screening, diabetes self-management training, and barium enemas, all with no copay, and digital rectal exams and EKG following Welcome Visit with 20% coinsurance.
Hearing Services See details
Hearing services include routine hearing exams with no copay and a coinsurance of at most 20%, and prescription hearing aids with no copay up to a maximum of $2200 per year. OTC hearing aids are covered with no copay.
Vision Services See details
The UHC Dual Complete NC-S3 (HMO-POS D-SNP) plan covers vision services, including eye exams with no copay, and eyewear with a combined maximum of $350 per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare Dental Services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, maxillofacial prosthetics, and prosthodontics, fixed are covered with no copay. Orthodontics and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment, prosthetic devices, medical supplies, and diabetic equipment. Durable medical equipment has a 20% coinsurance and requires authorization, while durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies have no copay. Diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, with a minimum coinsurance of 20% and 0% respectively. Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%, with a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete NC-S3 (HMO-POS D-SNP) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the UHC Dual Complete NC-S3 (HMO-POS D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
The UHC Dual Complete NC-S3 (HMO-POS D-SNP) plan does not cover 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, or Self-Directed Personal Assistance Services. Over-the-Counter (OTC) items are covered with no copay, and a meal benefit is covered with no copay and requires prior authorization.
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