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UHC Dual Complete TX-S001 (Regional PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete TX-S001 (Regional 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 TX-S001 (Regional PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete TX-S001 (Regional PPO D-SNP) is a Regional PPO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of Texas. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that UHC Dual Complete TX-S001 (Regional 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 TX-S001 (Regional 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 TX-S001 (Regional 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 TX-S001 (Regional PPO 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.
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 $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 combined Maximum Out-Of-Pocket cost of $9350.00 (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 $9350.00 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 TX-S001 (Regional PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, your Part D premium will be $18.30. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete TX-S001 (Regional PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1960 copay per admission, while outpatient services, primary care, and other services often have coinsurance between 0-20%. Emergency and ambulance services have a $110 copay and no copay, respectively. Preventive services, including an annual physical, have no copay. The plan also includes coverage for hearing aids, vision services, and dental services. Medical equipment and home infusion services have coinsurance, while home health services, lab services, and OTC items have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization, with a copay of $1960 per admission or stay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute have no copay for days 91-999, while 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 20% coinsurance, Ambulatory Surgical Center (ASC) Services with 0% - 20% coinsurance, Outpatient Substance Abuse Services with 0% - 20% coinsurance for individual sessions and 20% coinsurance for group sessions, and Outpatient Blood Services with 20% coinsurance. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete TX-S001 (Regional PPO D-SNP) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UHC Dual Complete TX-S001 (Regional PPO D-SNP) plan. All ambulance services have no copay and a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the UHC Dual Complete TX-S001 (Regional PPO D-SNP) plan. Emergency Services has a $110 copay and no coinsurance, while Urgently Needed Services have a copay between $0 and $45 with no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay and no coinsurance.
Primary Care See details
The UHC Dual Complete TX-S001 (Regional PPO D-SNP) plan covers primary care physician services with a coinsurance of 0% to 20%, chiropractic services with a 20% coinsurance (but not routine care), occupational therapy services with a 0% to 20% coinsurance, physician specialist services with a 0% to 20% coinsurance, and mental health specialty services with a 0% to 20% coinsurance for individual sessions and a 20% coinsurance for group sessions. The plan also covers podiatry services with a 20% coinsurance for routine foot care, other health care professional services with a 0% to 20% coinsurance, psychiatric services with a 0% to 20% coinsurance for individual sessions and a 20% coinsurance for group sessions, physical therapy and speech-language pathology services with a 0% to 20% coinsurance, additional telehealth benefits with no copay, and opioid treatment program services with no copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services. The additional preventive services include Fitness Benefit and Home and Bathroom Safety Devices and Modifications, both with no copay. Other preventive services like Glaucoma Screenings, Diabetes Self-Management Training, and Barium Enemas have no copay, while Digital Rectal Exams and EKGs following a Welcome Visit have 20% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams with a 20% coinsurance and no copay, as well as coverage for prescription hearing aids with a maximum plan benefit of $1500 per year and no copay. OTC hearing aids are covered with no copay. Fitting/Evaluation for Hearing Aid, 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 Dual Complete TX-S001 (Regional PPO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and the plan covers one routine eye exam per year; contact lenses are covered, and eyeglass lenses and frames are covered with a limit of one per year, and a combined maximum of $100.
Dental Services See details
Dental services are partially covered under the UHC Dual Complete TX-S001 (Regional PPO D-SNP) plan. Medicare Dental Services are covered with 20% coinsurance, while Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and a coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete TX-S001 (Regional PPO D-SNP) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, are covered by the UHC Dual Complete TX-S001 (Regional PPO D-SNP) plan. Durable Medical Equipment has a 15% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 15% coinsurance, and medical supplies have a 15% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 15% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests and Therapeutic Radiological Services have a coinsurance of up to 20%, while Diagnostic Radiological Services have a coinsurance of up to 20% but no minimum coinsurance. Lab Services have no copay, and Outpatient X-Ray Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete TX-S001 (Regional PPO 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 not covered by the UHC Dual Complete TX-S001 (Regional PPO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays. The plan requires prior authorization and charges the Medicare-defined cost share for tier 1, but does not specify copay or coinsurance information.
Other Services See details
The UHC Dual Complete TX-S001 (Regional PPO D-SNP) plan covers Over-the-Counter (OTC) Items with no copay. However, acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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