Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Complete Care NC-28 (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-28 (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
UHC Complete Care NC-28 (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 2025.
It's important to know that UHC Complete Care NC-28 (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-28 (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.
Below are a few key facts and commonly-asked questions about UHC Complete Care NC-28 (HMO-POS C-SNP).
The cost of a Medicare Advantage Plan is made up of four main parts.
For UHC Complete Care NC-28 (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 $255.00 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 $3900.00 (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 $3900.00 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.
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The UHC Complete Care NC-28 (HMO-POS C-SNP) plan has a $255.00 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy you use. For example, in the initial coverage phase, you will pay a $5.00 copay for preferred generic drugs at a standard pharmacy, and a $47.00 copay for standard generic drugs at a standard pharmacy. For preferred brand drugs, you will pay a $100.00 copay, and for non-preferred drugs, you will pay 30% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
The UHC Complete Care NC-28 (HMO-POS C-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. Emergency and primary care services have copays, while preventive services, vision exams, and some dental services have no copay. The plan also covers hearing exams, prescription hearing aids, and offers coverage for medical equipment with coinsurance. Other covered services include home health, skilled nursing, and dialysis services, each with specific copayments or coinsurance. Additionally, the plan includes benefits like OTC items and meal benefits with no copay.
Inpatient Hospital services, including acute and psychiatric care, are covered. For inpatient hospital-acute and psychiatric care, you'll pay a $395 copay for days 1-6, and no copay for days 7-90. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute and additional days for inpatient hospital psychiatric are not covered.
Outpatient Services, including all outpatient hospital services, are covered. Outpatient Hospital Services have a copay between $0 and $395, Observation Services have a $395 copay, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services have no copay. Individual sessions for outpatient substance abuse have a copay between $0 and $25, and group sessions have a $15 copay.
Partial Hospitalization is covered by the UHC Complete Care NC-28 (HMO-POS C-SNP) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services are covered by the UHC Complete Care NC-28 (HMO-POS C-SNP) plan. Medicare-covered ground and air ambulance services have a $195 copay, and there is no coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UHC Complete Care NC-28 (HMO-POS C-SNP) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a copay between $0 and $65. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have no copay.
The UHC Complete Care NC-28 (HMO-POS C-SNP) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a copay between $0 and $15, while physician specialist services have a copay between $0 and $15. Mental health specialty services, podiatry services, other health care professional services, and psychiatric services have varying copays depending on the service, with additional telehealth benefits having no copay, and opioid treatment program services having no copay. Physical therapy and speech-language pathology services have a copay between $0 and $15.
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing exams are covered with no copay, and routine hearing exams are covered once per year with no copay. Prescription hearing aids are covered with a copay between $199 and $1249, and OTC hearing aids are covered with a copay between $99 and $829. Fitting/Evaluation for Hearing Aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services include eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams and routine eye exams have no copay. Eyewear has a combined maximum of $200 every two years, and contact lenses have no copay. Eyeglass lenses have a copay between $0 and $153, and eyeglass frames have no copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services includes coverage for Medicare Dental Services with 20% coinsurance, Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services with no copay. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services are covered, but require prior authorization. There is a coinsurance of 20% for these services.
Medical Equipment is covered by the UHC Complete Care NC-28 (HMO-POS C-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered.
Prosthetics/Medical Supplies - Non-Medicare benefit and Prosthetic Devices have a 20% coinsurance, while Medical Supplies also have a 20% coinsurance.
Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, but Diabetic Equipment requires prior authorization.
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a $25 copay, lab services with no copay, diagnostic radiological services with a copay up to $105, therapeutic radiological services with coinsurance up to 20%, and outpatient X-ray services with a $15 copay. All services require prior authorization.
Home Health Services are covered by the UHC Complete Care NC-28 (HMO-POS C-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services are not covered by the UHC Complete Care NC-28 (HMO-POS C-SNP) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) services are covered by the UHC Complete Care NC-28 (HMO-POS C-SNP) plan, with prior authorization required. There is no copay for days 1-20, and a $203 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
The UHC Complete Care NC-28 (HMO-POS C-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay, while 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, and Self-Directed Personal Assistance Services are not covered.
SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
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