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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 2025, 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 4 out of 5 stars in 2025.
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 $16.10. 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 $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 TX-D007 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, your costs will vary depending on the specific drug tier, and where you fill your prescriptions. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your covered drugs. If you qualify for the low-income subsidy, the plan's premium is $16.10.
Additional Benefits
The UHC Dual Complete TX-D007 (HMO-POS D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $1860 copay per admission. Outpatient services, primary care, and other specialist services have a coinsurance between 0% and 20%. Emergency services have a $110 copay, while urgent care has a copay between $0 and $45. This plan includes no copays for many services, such as routine hearing exams, eye exams, dental services, and home health services. It also offers coverage for hearing aids up to $2200 annually. Additionally, the plan covers transportation to health-related locations, and offers no copay for outpatient blood services, and acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, which both require prior authorization. For Inpatient Hospital-Acute, you will pay a copay of $1860 per admission or stay, and additional days for inpatient hospital-acute have no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Inpatient Hospital Psychiatric does not cover additional days or non-Medicare-covered stays.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with 0-20% coinsurance, Observation Services with 20% coinsurance, Ambulatory Surgical Center (ASC) Services with 0-20% coinsurance, Outpatient Substance Abuse Services with 0-20% coinsurance, and Outpatient Blood Services with 20% coinsurance. This plan also waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, up to 48 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services include a $110 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $45, with no coinsurance. Worldwide Emergency Services include Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, all of which have no copay and no coinsurance.
Primary Care See details
The UHC Dual Complete TX-D007 (HMO-POS D-SNP) plan covers Primary Care Physician Services with a 0% to 20% coinsurance, Chiropractic Services with a 20% coinsurance, Routine Chiropractic Care with no copay, Occupational Therapy Services with a 0% to 20% coinsurance, Physician Specialist Services with a 0% to 20% coinsurance, and Mental Health Specialty Services with a 0% to 20% coinsurance for individual sessions and a 20% coinsurance for group sessions. The plan also covers Podiatry Services with a 20% coinsurance for Routine Foot Care, no copay for Medicare-covered Podiatry Services, Other Health Care Professional with a 0% to 20% coinsurance, Psychiatric Services with a 0% to 20% coinsurance for individual sessions and a 20% coinsurance for group sessions, Physical Therapy and Speech-Language Pathology Services with a 0% to 20% coinsurance, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other services are covered. Some additional preventive services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services. Other covered services include glaucoma screening, diabetes self-management training, and barium enemas with no copay, and a digital rectal exam and EKG following a welcome visit with 20% coinsurance.
Hearing Services See details
Hearing services for the UHC Dual Complete TX-D007 (HMO-POS D-SNP) plan include routine hearing exams with no copay and at most 20% coinsurance, and prescription hearing aids with no copay and a plan maximum benefit of $2200 every year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are covered with no copay.
Vision Services See details
Vision services include eye exams and eyewear, with no copay for eye exams, contact lenses, eyeglass lenses, and eyeglass frames. Eyeglasses (lenses and frames) and upgrades are not covered, while a combined maximum of $200 is covered for all eyewear annually.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery are also covered with no copay. However, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, and a coinsurance between 0% and 20%. Both Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete TX-D007 (HMO-POS D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment are covered. DME has a 20% coinsurance, and a prior authorization is required. Prosthetic Devices and Medicare-covered Medical Supplies have a 20% coinsurance, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have 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). Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete TX-D007 (HMO-POS D-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and coinsurance information is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the UHC Dual Complete TX-D007 (HMO-POS D-SNP) plan, but the additional days beyond Medicare-covered SNF and non-Medicare-covered stays are not covered. Prior authorization is required, and the copay information can be found in the plan details.
Other Services See details
Under the UHC Dual Complete TX-D007 (HMO-POS D-SNP) plan, acupuncture is covered with no copay, but is limited to 6 treatments per year. Over-the-counter (OTC) items are covered with no copay, including nicotine replacement therapy and naloxone, but not all drugs on the CMS OTC list. Other services, including meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and private duty nursing services are not covered.
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