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UHC Dual Complete HI-S001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete HI-S001 (PPO 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 HI-S001 (PPO D-SNP) in 2026, please refer to our full plan details page.
UHC Dual Complete HI-S001 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2026 to people living in State of Hawaii. The overall rating for this plan is not yet available for 2026.
It's important to know that UHC Dual Complete HI-S001 (PPO 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 HI-S001 (PPO 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 HI-S001 (PPO 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 HI-S001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $42.90. 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 combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 HI-S001 (PPO D-SNP) Medicare plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are covered with no copay for a 1-month or 3-month supply at standard pharmacies and standard mail order. This provides an affordable option for individuals relying on common generic medications. For higher-tier medications, the plan transitions to a coinsurance model during the initial coverage phase. Tier 2 generic drugs, Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs all carry a 25% coinsurance for standard pharmacy and standard mail order options. This consistent percentage allows you to easily project your out-of-pocket costs for brand-name and specialty prescriptions.
Additional Benefits
The UHC Dual Complete HI-S001 (PPO D-SNP) plan offers robust health coverage with many essential services requiring no copay. Beneficiaries enjoy no copay for primary care, specialist visits, home health, and preventive care, with coinsurance ranging from 0% to 20%. Dental services are covered up to a $2,000 annual limit with no copay, while diagnostic hearing and vision services also feature no copays or coinsurance. For emergency and hospital care, the plan features a $115 emergency room copay, which is waived if admitted, and a $2,030 copay per inpatient hospital stay. Outpatient procedures, dialysis, and durable medical equipment are covered with no copay and a 20% coinsurance. Additionally, members can access up to 24 one-way transportation trips and select over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by UHC Dual Complete HI-S001 (PPO D-SNP) with a $2030.00 copay per stay and no coinsurance for Medicare-covered acute and psychiatric stays, though prior authorization is required. Unlimited additional acute days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
UHC Dual Complete HI-S001 (PPO D-SNP) covers outpatient services with no copay, with coinsurance ranging from no coinsurance to 20% for outpatient hospital, ambulatory surgical center, and substance abuse services. Outpatient blood services are also covered with no copay and 20% coinsurance, and the deductible is waived.
Partial Hospitalization See details
UHC Dual Complete HI-S001 (PPO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the UHC Dual Complete HI-S001 (PPO D-SNP) plan, with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance, providing up to 24 one-way trips per year to plan-approved health-related locations, while trips to any health-related location are not covered.
Emergency Services See details
UHC Dual Complete HI-S001 (PPO 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 have a copay ranging from $0 to $40 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 HI-S001 (PPO D-SNP) covers primary care, specialist, and mental health services with no copays and coinsurance ranging from 0% to 20%. Chiropractic care is partially covered, offering up to 20 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by UHC Dual Complete HI-S001 (PPO D-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, and select fitness and caregiver support programs. Additional preventive benefits are only partially covered, excluding services such as health education, nutritional therapy, and personal emergency response systems, while digital rectal exams and EKGs following a welcome visit require a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by UHC Dual Complete HI-S001 (PPO D-SNP), which offers diagnostic hearing exams with no copay, no coinsurance, and no deductible, subject to prior authorization. However, routine hearing exams, fitting and evaluations, prescription hearing aids, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
UHC Dual Complete HI-S001 (PPO D-SNP) covers vision services with no copay and no coinsurance. Although some services are covered, routine eye exams, other eye exam services, contact lenses, eyeglasses, and upgrades are not covered in practice.
Dental Services See details
UHC Dual Complete HI-S001 (PPO D-SNP) offers partially covered dental services with a $2,000 annual limit, requiring no copay and a 20% coinsurance for Medicare-covered dental care, and no copay and no coinsurance for most other preventive and comprehensive services. Implant services and orthodontics are not covered by this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by UHC Dual Complete HI-S001 (PPO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, range from no coinsurance to 20% coinsurance, with insulin drugs requiring a $35 copay.
Dialysis Services See details
UHC Dual Complete HI-S001 (PPO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for this covered benefit.
Medical Equipment See details
UHC Dual Complete HI-S001 (PPO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by UHC Dual Complete HI-S001 (PPO D-SNP) with prior authorization, featuring no copay for lab services and no copay or coinsurance for diagnostic radiological services. Diagnostic procedures and tests require a copay and 20% coinsurance, while therapeutic radiology and outpatient X-rays have no copay but require 20% coinsurance.
Home Health Services See details
Home Health Services are covered by UHC Dual Complete HI-S001 (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by UHC Dual Complete HI-S001 (PPO D-SNP) with no copay, but some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a 20% coinsurance. Prior authorization is required for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by UHC Dual Complete HI-S001 (PPO D-SNP) with no copay and no coinsurance, subject to prior authorization. This benefit allows for admission without a prior three-day inpatient hospital stay, though additional days beyond the standard Medicare-covered benefit are not covered.
Other Services See details
UHC Dual Complete HI-S001 (PPO D-SNP) provides partial coverage for other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is limited to 20 treatments per year, while meal benefits and highly integrated services are not covered.
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