A non-government entity
UHC Dual Complete TX-V005 (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-V005 (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-V005 (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete TX-V005 (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 Cameron, Hidalgo, and Willacy Counties. 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-V005 (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-V005 (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-V005 (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-V005 (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 $0.40. 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 $502.00 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 $4200.00 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:
Sign up for UHC Dual Complete TX-V005 (HMO-POS D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The UHC Dual Complete TX-V005 (HMO-POS D-SNP) Medicare plan features an annual prescription drug deductible of $502. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay for supply fills at standard pharmacies and through standard mail order. This plan provides affordable access to everyday generic medications to help keep your out-of-pocket healthcare costs low. For brand-name and specialized medications, the plan transitions to a coinsurance model. Members will pay a 25% coinsurance for Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs. This 25% coinsurance rate applies to standard pharmacy fills as well as standard mail order services.
Additional Benefits
The UHC Dual Complete TX-V005 (HMO-POS D-SNP) offers robust healthcare coverage with many essential services featuring no copay and no coinsurance. You will pay no copay for primary care visits, telehealth, home health services, and routine preventive screenings. When specialized care is needed, specialist office visits carry a copay of up to $30, while inpatient hospital stays require a $395 copay per admission. Additional perks include dental, vision, and hearing benefits, featuring no copay for routine annual exams alongside allowances for eyewear and hearing aids. Members also benefit from over-the-counter item coverage and up to 24 one-way transportation trips per year to approved locations with no copay. Emergency room visits require a $150 copay, which is waived if you are admitted, and skilled nursing care is covered with no copay for the first 20 days.
Inpatient Hospital See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) covers inpatient acute and psychiatric hospital services with a $395 copay per admission and no coinsurance. While unlimited additional acute care days are covered with no copay, this plan does not cover non-Medicare-covered stays, upgrades, or additional psychiatric days.
Outpatient Services See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital and observation services require a copay between $0 and $395 with no coinsurance, while outpatient substance abuse sessions carry a copay of $0 to $25 and no coinsurance.
Partial Hospitalization See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Both a referral and prior authorization are required to receive this covered care.
Ambulance and Transportation Services See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) covers ground and air ambulance services with a $290 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by UHC Dual Complete TX-V005 (HMO-POS D-SNP) with a $150 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 $65 with 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-V005 (HMO-POS D-SNP) offers primary care and telehealth services with no copay and no coinsurance. Specialist visits, therapies, mental health, and podiatry services are also covered with no coinsurance and copays ranging from $0 to $30, while routine chiropractic care is not covered.
Preventive Services See details
Preventive services are covered by UHC Dual Complete TX-V005 (HMO-POS D-SNP) with no copay and no coinsurance for annual exams, kidney disease education, screenings, fitness, weight management, in-home support, caregiver support, and home safety devices. However, the benefit is only partially covered because health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, alternative therapies, therapeutic massage, adult day health services, nutritional or dietary benefits, home-based palliative care, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete TX-V005 (HMO-POS D-SNP), featuring no copay and no coinsurance for one routine annual hearing exam. Up to two prescription hearing aids (copays of $199.00 to $1,249.00) and OTC hearing aids (copays of $199.00 to $829.00) are covered yearly with no coinsurance, though hearing aid fittings, evaluations, and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) vision services are partially covered, offering routine eye exams (one per year) with no copay and no coinsurance, though other eye exams, upgrades, and eyeglasses (lenses and frames) are not covered. Covered eyewear features no coinsurance and a $150 limit every two years, with no copay for contact lenses and frames, and a $0 to $153 copay for lenses.
Dental Services See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) offers partially covered dental services, with implant services and orthodontics being excluded from coverage. Preventive care is provided with no copay and no coinsurance up to a $1,000 annual maximum, while Medicare-covered dental services require no copay and 20% coinsurance, and covered comprehensive services require no copay and 50% coinsurance.
Home Infusion bundled Services See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Associated Medicare Part B chemotherapy and other drugs carry no copay and 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
UHC Dual Complete TX-V005 (HMO-POS D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) covers medical equipment with no copay for durable medical equipment (DME), prosthetics, and diabetic supplies. A 20% coinsurance applies to DME, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts, and prior authorization is required.
Diagnostic and Radiological Services See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) covers diagnostic and radiological services, requiring referrals and prior authorization for both. Members pay a $50 copay and no coinsurance for diagnostic tests, no copay for lab and diagnostic radiological services, a $25 copay for outpatient X-rays, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the UHC Dual Complete TX-V005 (HMO-POS D-SNP) plan. This lack of coverage applies to all related sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation.
Skilled Nursing Facility (SNF) See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance and no prior 3-day inpatient hospital stay required. There is no copay for days 1 to 20, followed by a $218 daily copay for days 21 to 100, with prior authorization and referrals required.
Other Services See details
UHC Dual Complete TX-V005 (HMO-POS D-SNP) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture, meal benefits, and highly integrated services are not covered. Covered OTC benefits include nicotine replacement therapy and naloxone, which are available through claims processing and reimbursement.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved