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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 2026, 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 3.5 out of 5 stars in 2026.
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 $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 $615.00 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-S5 (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for standard pharmacy fills of one-month or three-month supplies, as well as for three-month standard mail orders. This makes essential generic medications highly accessible and affordable under this plan. For Tier 2 generic, Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, members are responsible for a 25% coinsurance. This 25% coinsurance rate applies to both standard pharmacy fills and standard mail order options where available. Understanding these cost-sharing tiers helps you accurately estimate your yearly out-of-pocket costs.
Additional Benefits
The UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan offers robust coverage with many services requiring no copays, helping members manage their healthcare costs effectively. For inpatient hospital stays, members pay a $1,980 copay per stay with no coinsurance, while outpatient services, primary care, and specialist visits feature no copays and coinsurance ranging from 0% to 20%. Emergency services carry a $115 copay, which is waived if admitted, while routine home health care and skilled nursing facility services are covered with no copay and no coinsurance. This plan also provides valuable supplemental benefits, including dental and vision care with no copays and no coinsurance up to annual limits of $2,500 and $300, respectively. Members benefit from routine hearing exams with no copay and 20% coinsurance, hearing aids with no copay, and up to 48 one-way transportation trips per year to plan-approved locations at no cost. Additionally, over-the-counter items and home infusion are covered with no copays, while durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
UHC Dual Complete TX-S5 (HMO-POS D-SNP) partially covers inpatient hospital services, featuring a $1,980 copay per stay and no coinsurance for Medicare-covered acute and psychiatric admissions. While unlimited additional acute care days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by UHC Dual Complete TX-S5 (HMO-POS D-SNP) with no copayments, although a coinsurance of 0% to 20% applies depending on the specific service. This coverage includes outpatient hospital care, ambulatory surgical center visits, substance abuse therapy, and blood services, which generally require prior authorization and referrals.
Partial Hospitalization See details
UHC Dual Complete TX-S5 (HMO-POS D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
UHC Dual Complete TX-S5 (HMO-POS D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by UHC Dual Complete TX-S5 (HMO-POS D-SNP) with a $115 copay—which is waived if admitted to the hospital within 24 hours—and no coinsurance. Urgently needed services feature a copay ranging from no copay to $40 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Primary care and specialist services under the UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan feature no copay and 0% to 20% coinsurance, while physical, occupational, and speech therapies require no copay and 20% coinsurance. Chiropractic services are not covered, but telehealth and opioid treatment are available with no copays and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by UHC Dual Complete TX-S5 (HMO-POS D-SNP), offering annual physical exams, kidney disease education, and fitness benefits 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, personal emergency response systems (PERS), medical nutrition therapy, and therapeutic massage.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete TX-S5 (HMO-POS D-SNP), featuring routine hearing exams with 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 over-the-counter hearing aids are both covered with no copay and no coinsurance, with a maximum plan benefit of $2,200 every two years for prescription aids.
Vision Services See details
UHC Dual Complete TX-S5 (HMO-POS D-SNP) vision services are partially covered, offering routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames with no copay, no coinsurance, and no deductible up to a $300 annual eyewear limit. Other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by UHC Dual Complete TX-S5 (HMO-POS D-SNP), offering no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other preventive and comprehensive services up to a $2,500 annual limit. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
UHC Dual Complete TX-S5 (HMO-POS D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and radiation, carry a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by UHC Dual Complete TX-S5 (HMO-POS D-SNP) 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-S5 (HMO-POS D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic shoes and inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete TX-S5 (HMO-POS D-SNP) with prior authorization and referrals required. Outpatient diagnostic procedures and tests require a copayment and 20% coinsurance, while lab services have no copay, and radiological services have no copays with coinsurance ranging from no coinsurance for diagnostic radiology to 20% for therapeutic radiology and X-rays.
Home Health Services See details
Home health services are covered by UHC Dual Complete TX-S5 (HMO-POS D-SNP) with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the UHC Dual Complete TX-S5 (HMO-POS D-SNP) plan 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, alongside prior authorization and referrals.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by UHC Dual Complete TX-S5 (HMO-POS D-SNP) with no copay and no coinsurance, though prior authorization and referrals are required. While the plan allows admission without a prior three-day inpatient hospital stay, additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other services are partially covered by UHC Dual Complete TX-S5 (HMO-POS D-SNP), offering over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and highly integrated services for dual-eligible SNPs are not covered under this benefit.
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