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UHC Dual Complete KY-S4 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete KY-S4 (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 KY-S4 (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete KY-S4 (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 State of Kentucky. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that UHC Dual Complete KY-S4 (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 KY-S4 (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 KY-S4 (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 KY-S4 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.40. 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 KY-S4 (HMO-POS D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, members benefit from no copay for both 1-month and 3-month supplies at standard pharmacies and standard mail order. Tier 2 generic drugs require a 25% coinsurance for both 1-month and 3-month supplies. Tier 3 preferred brand medications also carry a 25% coinsurance for standard pharmacy and mail-order fills. Additionally, Tier 4 non-preferred drugs and Tier 5 specialty tier drugs require a 25% coinsurance for 1-month supplies. This structured pricing helps you easily estimate your out-of-pocket costs for various medication tiers.
Additional Benefits
The UHC Dual Complete KY-S4 (HMO-POS D-SNP) offers comprehensive medical coverage with no copay for primary care, outpatient services, and skilled nursing facility stays, though coinsurance up to 20% may apply to some services. Inpatient hospital admissions require a $1,860 copay with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Routine transportation is also covered with no copay or coinsurance for up to 36 one-way trips per year to approved locations. This plan also features robust supplemental benefits, including no copay and no coinsurance for routine vision exams, dental care up to $2,500 annually, and hearing aids up to $2,200 every two years. Preventive services, diabetic supplies, and over-the-counter items are also covered with no copay and no coinsurance. Most other medical equipment, dialysis services, and specialized outpatient therapies require no copay and a 20% coinsurance.
Inpatient Hospital See details
UHC Dual Complete KY-S4 (HMO-POS D-SNP) partially covers inpatient hospital services, requiring a $1,860 copay per admission and no coinsurance for Medicare-covered acute and psychiatric stays. While unlimited additional acute care days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
UHC Dual Complete KY-S4 (HMO-POS D-SNP) outpatient services are covered with no copays, with coinsurance ranging from 0% to 20% depending on the service. Covered benefits include outpatient hospital care, ambulatory surgical center services, substance abuse therapy, and blood services, most of which require prior authorization.
Partial Hospitalization See details
Partial hospitalization services are covered by UHC Dual Complete KY-S4 (HMO-POS D-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
UHC Dual Complete KY-S4 (HMO-POS D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
UHC Dual Complete KY-S4 (HMO-POS D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $0 to $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with no copay and no coinsurance.
Primary Care See details
UHC Dual Complete KY-S4 (HMO-POS D-SNP) covers primary care, specialist, and mental health services with no copays and coinsurance ranging from no coinsurance to 20%, while chiropractic services are not covered in practice. Physical, occupational, and speech therapies require no copay and a 20% coinsurance, and telehealth and opioid treatment are available with no copay and no coinsurance.
Preventive Services See details
UHC Dual Complete KY-S4 (HMO-POS D-SNP) covers preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, and fitness benefits, while a 20% coinsurance applies to digital rectal exams and post-welcome visit EKGs. Additional supplemental preventive services are partially covered, excluding benefits such as health education, personal emergency response systems (PERS), and nutritional counseling.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete KY-S4 (HMO-POS D-SNP), offering one annual routine exam with no copay, 20% coinsurance, and no deductible, while fitting and evaluation exams are not covered. Prescription hearing aids (up to $2,200 every two years) and OTC hearing aids are available with no copay and no coinsurance, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by UHC Dual Complete KY-S4 (HMO-POS D-SNP) with no copay and no coinsurance for covered services, which include one routine eye exam and up to $200 annually for contact lenses, eyeglass lenses, and eyeglass frames. Other eye exams, combined eyeglasses (lenses and frames), and upgrades are not covered under this plan.
Dental Services See details
Dental Services are partially covered by UHC Dual Complete KY-S4 (HMO-POS D-SNP), offering up to $2,500 in annual coverage with no copay and no coinsurance for preventive and most comprehensive care, though implant services and orthodontics are not covered. Medicare-covered dental services are also available with no copay and a 20% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Dual Complete KY-S4 (HMO-POS D-SNP) with no copay and no coinsurance, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs feature no copay and coinsurance ranging from no coinsurance to 20%, while insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by UHC Dual Complete KY-S4 (HMO-POS D-SNP) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
UHC Dual Complete KY-S4 (HMO-POS D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and 20% coinsurance. Diabetic supplies are covered with no copay and no coinsurance, while diabetic therapeutic shoes and inserts require 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under UHC Dual Complete KY-S4 (HMO-POS D-SNP) with prior authorization, featuring no copay and no coinsurance for diagnostic radiological services. Lab services have no copay but require coinsurance, while diagnostic procedures, therapeutic radiology, and outpatient X-rays require a minimum 20% coinsurance, with diagnostic procedures also requiring a copay.
Home Health Services See details
UHC Dual Complete KY-S4 (HMO-POS D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
UHC Dual Complete KY-S4 (HMO-POS D-SNP) provides Cardiac Rehabilitation Services with no copay, though prior authorization is required. While some services are covered, specific programs including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UHC Dual Complete KY-S4 (HMO-POS D-SNP) with no copay and no coinsurance, though prior authorization is required and admission does not require a prior three-day hospital stay. This benefit is partially covered, as the plan does not cover additional days beyond the standard Medicare-covered limit.
Other Services See details
Other services are partially covered by UHC Dual Complete KY-S4 (HMO-POS D-SNP), which provides over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and highly integrated services for dual-eligible SNPs are not covered, and prior authorization is required for the meal benefit.
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* 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.
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