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UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) in 2025, please refer to our full plan details page.
UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) is a HMO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Miami-Dade and Broward Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that UHC MedicareMax Dual Complete FL-D4 (HMO 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 MedicareMax Dual Complete FL-D4 (HMO 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 MedicareMax Dual Complete FL-D4 (HMO 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 MedicareMax Dual Complete FL-D4 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.30. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.80. 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 MedicareMax Dual Complete FL-D4 (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly premium for Part D will be $20.30. In the initial coverage phase, after you pay the deductible, you will pay the costs for your drugs, but the specific costs for each tier are not provided in this summary. Once your total drug costs reach $2000, you will enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Part D covered drugs.
Additional Benefits
The UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) plan offers a wide range of benefits with a focus on low-cost access to care. Many services have no copay, including preventive care, primary care, mental health services, hearing exams, vision services, dental services, home health services, and medical equipment. You will pay a $2,000 copay per admission for inpatient hospital stays, and a $110 copay for emergency services.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which have a copay of $2,000 per admission or stay for Medicare-covered services. Additional Days for Inpatient Hospital-Acute have no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 0% - 20% coinsurance, Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a 0% - 20% coinsurance, Outpatient Substance Abuse Services with no copay, and Outpatient Blood Services with no copay. All services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization and has no copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) plan. All Ambulance Services are covered with a copay for both ground and air ambulance services, and there is no coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) plan covers primary care physician services with a coinsurance of 0-20%, chiropractic services with no copay, occupational therapy services with a coinsurance of 0-20%, physician specialist services with no copay, and mental health specialty services, individual and group sessions with no copay. This plan also covers podiatry services with a coinsurance of 20% for routine foot care, and no copay, other health care professional services, psychiatric services, individual and group sessions with no copay, physical therapy and speech-language pathology services with a coinsurance of 0-20%, additional telehealth benefits with no copay, and opioid treatment program services with no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Annual Physical Exams with no copay, and additional preventive services, including Fitness Benefit, In-Home Support Services, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, with no copay. 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, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) are not covered.
Hearing Services See details
Hearing exams are covered with no copay. Prescription hearing aids have a plan-specified amount of $2200 every year with no copay for prescription hearing aids (all types) and OTC hearing aids are covered with no copay. Fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
The UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $300 every year. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
The UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) plan covers dental services with no copay for oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, prosthodontics (removable), and oral and maxillofacial surgery; however, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. This plan also requires prior authorization for some dental services.
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. There is no copay for Medicare Part B Insulin Drugs, and Medicare Part B Chemotherapy/Radiation Drugs. The plan requires prior authorization.
Dialysis Services See details
Dialysis Services are covered under the UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) plan. There is no copay for dialysis services.
Medical Equipment See details
Medical Equipment is covered by the UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) plan. Durable Medical Equipment (DME), Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts have no copay and no coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and lab services with no copay, and radiological services. Diagnostic Radiological Services, 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 MedicareMax Dual Complete FL-D4 (HMO 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 the plan does not cover any of the sub-services, including Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Additional Cardiac Rehabilitation Services, Medicare-covered Intensive Cardiac Rehabilitation Services, and Medicare-covered Pulmonary Rehabilitation Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) plan, with no copay for days 1-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
The UHC MedicareMax Dual Complete FL-D4 (HMO D-SNP) plan's Other Services benefit covers over-the-counter items and meal benefits. Over-the-counter items have no copay, and meal benefits also have no copay, but require prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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