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UHC Complete Care NC-25 (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Complete Care NC-25 (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 NC-25 (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
UHC Complete Care NC-25 (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 North Carolina. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that UHC Complete Care NC-25 (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 NC-25 (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 NC-25 (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 NC-25 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $520.00 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 $5400.00 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 NC-25 (HMO-POS C-SNP) Medicare plan features an annual drug deductible of $520. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies, nor for a 3-month supply through mail order. Tier 2 generic drugs cost $10 for a 1-month standard pharmacy supply, but there is no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs require an 18% coinsurance for both standard pharmacy and mail order options. Tier 4 non-preferred drugs carry a 43% coinsurance for a 1-month supply. Finally, Tier 5 specialty medications require a 27% coinsurance for a 1-month supply at standard pharmacies and mail order.
Additional Benefits
The UHC Complete Care NC-25 (HMO-POS C-SNP) plan offers robust coverage with many essential services requiring no copay and no coinsurance, including primary care, routine preventive care, and home health services. For inpatient hospital stays, members pay a daily copay for the first several days with no copay for subsequent days, while specialist visits carry a low copay of up to $30. Emergency room visits require a $130 copay, which is waived upon admission, and worldwide emergency services are covered with no copay. Routine dental, vision, and hearing exams are fully covered with no copay, though hardware like hearing aids and eyewear require copayments. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, whereas diabetic supplies are available with no copay or coinsurance. Additionally, the plan includes valuable extra benefits such as over-the-counter items and post-discharge meals at no copay or coinsurance.
Inpatient Hospital See details
UHC Complete Care NC-25 (HMO-POS C-SNP) offers partially covered inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $495 copay for days 1-5 and no copay for days 6 and beyond, while psychiatric stays require a $495 copay for days 1-4 and no copay for days 5-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
UHC Complete Care NC-25 (HMO-POS C-SNP) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a copay of $0.00 to $495.00, and outpatient substance abuse services carry a copay of $0.00 to $25.00 for individual sessions and $15.00 for group sessions, with prior authorization required for most benefits.
Partial Hospitalization See details
Partial hospitalization services are covered under the UHC Complete Care NC-25 (HMO-POS C-SNP) plan with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
UHC Complete Care NC-25 (HMO-POS C-SNP) covers Medicare-approved ground and air ambulance services with a $290 copay and no coinsurance, subject to prior authorization. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
UHC Complete Care NC-25 (HMO-POS C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay of $0 to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance.
Primary Care See details
UHC Complete Care NC-25 (HMO-POS C-SNP) features no copays and no coinsurance for primary care, telehealth, and opioid treatment, while specialist and therapy services require a $0 to $30 copay and no coinsurance. Mental health services range from no copay to a $25 copay with no coinsurance, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive Services are partially covered by UHC Complete Care NC-25 (HMO-POS C-SNP) with no copay and no coinsurance for covered benefits such as annual physical exams, kidney disease education, fitness benefits, and home safety modifications. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy.
Hearing Services See details
Hearing services are partially covered by UHC Complete Care NC-25 (HMO-POS C-SNP), featuring no copay and no coinsurance for an annual routine hearing exam, though hearing aid fitting and evaluations are not covered. Covered prescription hearing aids (up to two per year) require a copay of $199.00 to $1,249.00 and no coinsurance, but inner ear, outer ear, and over the ear models are not covered. Up to two OTC hearing aids are also covered each year with no coinsurance and a copay ranging from $199.00 to $829.00.
Vision Services See details
Vision services are partially covered by UHC Complete Care NC-25 (HMO-POS C-SNP) with no deductible and no coinsurance. Routine eye exams are covered with no copay, while contact lenses, eyeglass frames, and eyeglass lenses (with a copay of $0 to $153) are covered up to a $250 combined limit every two years; however, other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
UHC Complete Care NC-25 (HMO-POS C-SNP) dental services are partially covered, offering preventive care like exams, cleanings, and x-rays with no copay and no coinsurance, alongside Medicare-covered dental with no copay and 20% coinsurance. However, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Complete Care NC-25 (HMO-POS C-SNP) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the UHC Complete Care NC-25 (HMO-POS C-SNP) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
UHC Complete Care NC-25 (HMO-POS C-SNP) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic equipment and supplies are also covered with no copay and no coinsurance, though prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Complete Care NC-25 (HMO-POS C-SNP), with prior authorization required for all services. Lab services and diagnostic radiological services feature no copay and no coinsurance, diagnostic procedures require a $50 copay with no coinsurance, outpatient X-rays require a $25 copay, and therapeutic radiological services incur a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by UHC Complete Care NC-25 (HMO-POS C-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under UHC Complete Care NC-25 (HMO-POS C-SNP) with no copay and no coinsurance, subject to prior authorization. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
UHC Complete Care NC-25 (HMO-POS C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
UHC Complete Care NC-25 (HMO-POS C-SNP) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, though prior authorization is required for meals. Acupuncture and other additional services in this category are not covered.
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