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UHC Dual Complete TX-S5 (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-S5 (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-S5 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete TX-S5 (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-S5 (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-S5 (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-S5 (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-S5 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.70. 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-S5 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay the costs for your prescriptions based on the drug tier, pharmacy, and whether you are using a 30, 60, or 90 day supply. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Part D covered drugs. However, your premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $1625 copay per admission, while outpatient services, primary care, and other specialist services have coinsurance between 0% and 20%. Emergency services cost $110, and ambulance services have a 20% coinsurance. This plan also provides coverage for preventive, hearing, vision, and dental services, often with no copay or a 20% coinsurance. Home health services have no copay, and several other services like acupuncture and over-the-counter items are covered with no copay. However, some services like cardiac rehabilitation and additional home health care hours are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $1625 per admission or stay. Additional Days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by this plan. Outpatient hospital services have a coinsurance of 0% to 20%, observation services have a 20% coinsurance, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
The UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan covers ambulance services 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 for up to 48 one-way trips per year via taxi or medical transport, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan, with a $110 copay. Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, have no copay.
Primary Care See details
The UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan covers primary care physician services with a coinsurance between 0% and 20%. Chiropractic services are covered with a 20% coinsurance, and routine chiropractic care has no copay. Occupational therapy services are covered with a coinsurance between 0% and 20%. Physician specialist services, mental health specialty services, and psychiatric services are covered with a coinsurance between 0% and 20%. Podiatry services are covered with a 20% coinsurance, and routine foot care has a copay of $0. Additional telehealth benefits have no copay, and opioid treatment program services have no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, an annual physical exam with no copay, and additional preventive services. Additional preventive services may have a copay, and some services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay and at most 20% coinsurance, and you get one exam every year. Prescription hearing aids have no copay, and OTC hearing aids have no copay.
Vision Services See details
The UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and routine eye exams are limited to one per year, while eyewear has a combined maximum benefit of $350 per year. Contact lenses, eyeglass lenses, and eyeglass frames are covered, but eyeglasses and upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services. Other services such as oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no copay. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment with a 20% coinsurance for Medicare-covered Diabetic Supplies and a 20% coinsurance for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a coinsurance of at most 20% with a minimum of 0%, and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20% with a minimum of 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan, but prior authorization is required. The plan does not offer additional days beyond Medicare-covered for SNF or a non-Medicare-covered stay for SNF.
Other Services See details
The UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan covers acupuncture with no copay for 6 treatments per year, and also covers over-the-counter items with no copay, including nicotine replacement therapy and naloxone. However, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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