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UHC Dual Complete TX-D007 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete TX-D007 (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 TX-D007 (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete TX-D007 (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 Texas. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that UHC Dual Complete TX-D007 (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 TX-D007 (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 TX-D007 (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 TX-D007 (HMO-POS D-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. Additionally, this plan comes with a Part B Premium reduction of $0.50. 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 $464.00 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 $9250.00 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 TX-D007 (HMO-POS D-SNP) Medicare plan has an annual drug deductible of $464. Under this plan, there is no copay for Tier 1 preferred generic and Tier 2 generic medications when using standard pharmacy or standard mail order services. For higher-tier prescription medications, members are responsible for a 25% coinsurance instead of a flat copayment. This 25% coinsurance applies to Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty tier medications filled at standard pharmacies or through standard mail order.
Additional Benefits
The UHC Dual Complete TX-D007 (HMO-POS D-SNP) offers comprehensive coverage with many essential services requiring no copay, including primary care, specialist visits, and home health care. While inpatient hospital stays require a $2,065 copay per stay, outpatient services and diagnostic labs feature no copay, though some medical services and durable medical equipment may carry a 20% coinsurance. Emergency room visits require a $115 copay, which is waived if you are admitted within 24 hours. This plan also includes valuable supplemental benefits such as dental, vision, hearing, and transportation services with no copayments. Members receive up to $1,500 annually for dental care, a $200 yearly allowance for vision hardware, and up to $2,200 every two years for prescription hearing aids. Additionally, the plan covers over-the-counter items with no copay and offers up to 24 free one-way trips per year to plan-approved locations.
Inpatient Hospital See details
Inpatient hospital services are partially covered by UHC Dual Complete TX-D007 (HMO-POS D-SNP), requiring a $2,065.00 copay per stay and no coinsurance for Medicare-covered acute and psychiatric admissions. While unlimited additional acute days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
UHC Dual Complete TX-D007 (HMO-POS D-SNP) covers outpatient services with no copay, though coinsurance ranges from no coinsurance to 20% depending on the specific service. Covered benefits include outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, most of which require prior authorization and a referral.
Partial Hospitalization See details
UHC Dual Complete TX-D007 (HMO-POS D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by UHC Dual Complete TX-D007 (HMO-POS D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 24 yearly one-way trips to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
UHC Dual Complete TX-D007 (HMO-POS D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $0 to $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
UHC Dual Complete TX-D007 (HMO-POS D-SNP) offers primary care, specialist, and mental health services with no copay and 0% to 20% coinsurance, while physical, occupational, and speech therapies require no copay and 20% coinsurance. Additional telehealth and opioid treatment services are available with no copay and no coinsurance, though chiropractic services are not covered under this plan.
Preventive Services See details
UHC Dual Complete TX-D007 (HMO-POS D-SNP) partially covers preventive services, offering annual physical exams, fitness benefits, and caregiver support with no copay and no coinsurance, while digital rectal exams and post-welcome visit EKGs require a 20% coinsurance. Several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and alternative therapies.
Hearing Services See details
UHC Dual Complete TX-D007 (HMO-POS D-SNP) offers partially covered hearing services with no deductible, including one routine hearing exam per year for no copay and a 20% coinsurance, though fitting and evaluation exams are not covered. Prescription hearing aids (excluding inner ear, outer ear, and over the ear types) and OTC hearing aids are covered with no copay and no coinsurance, featuring a $2,200 maximum coverage limit every two years for prescription devices.
Vision Services See details
Vision services are partially covered by UHC Dual Complete TX-D007 (HMO-POS D-SNP) with no copays, no coinsurance, and no deductibles, including one annual routine eye exam and a $200 yearly limit for contact lenses, eyeglass lenses, and frames. Other eye exam services, upgrades, and packaged eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered under UHC Dual Complete TX-D007 (HMO-POS D-SNP), providing up to $1,500 annually for preventive and comprehensive care with no copay and no coinsurance, though implant services and orthodontics are not covered. Medicare-covered dental services are available with no copay and a 20% coinsurance, subject to prior authorization and referral requirements.
Home Infusion bundled Services See details
UHC Dual Complete TX-D007 (HMO-POS D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by UHC Dual Complete TX-D007 (HMO-POS D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
UHC Dual Complete TX-D007 (HMO-POS D-SNP) covers durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with prior authorization required. Covered DME, prosthetics, medical supplies, and diabetic supplies feature no copay and a 20% coinsurance, while diabetic therapeutic shoes and inserts carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete TX-D007 (HMO-POS D-SNP), requiring prior authorization and referrals. Lab services feature no copay, while diagnostic procedures and tests require a copay and 20% coinsurance. Diagnostic radiological services feature no copay or coinsurance, whereas therapeutic radiology and outpatient X-rays carry a 20% coinsurance and no copay.
Home Health Services See details
UHC Dual Complete TX-D007 (HMO-POS D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by UHC Dual Complete TX-D007 (HMO-POS D-SNP) with no copay, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete TX-D007 (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and referrals are required. While the plan does not require a prior three-day hospital stay for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
UHC Dual Complete TX-D007 (HMO-POS D-SNP) partially covers Other Services, offering over-the-counter (OTC) items with no copay and no coinsurance, which includes nicotine replacement therapy and naloxone. Acupuncture and meal benefits are not covered under this plan.
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