A non-government entity
UnitedHealthcare
Plan ID: H0294-50-0
Plan Summary PageUHC Dual Complete NM-Q1 (PPO D-SNP)
2027 UHC Dual Complete NM-Q1 (PPO D-SNP) H0294 — 050 — 0 is a Medicare Advantage plan with drug coverage. It has received a 3-out-of-5 star rating from CMS for 2027.
Learn more about UHC Dual Complete NM-Q1 (PPO D-SNP) H0294 - 050 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.
3 / 5 stars for 2027
$0.00 /mo
Monthly premium
$75.00
Drug deductible
$9850.00 / $14800.00
Out-of-pocket maximum (In-Network / Combined)
Enroll online
Call to enroll
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Get personalized help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Plan Overview
2027 UHC Dual Complete NM-Q1 (PPO D-SNP) H0294 — 050 — 0 is a PPO D-SNP offered in State of New Mexico by Unitedhealthcare Insurance Company. It has a monthly premium of $0.00.
Important:
2027 UHC Dual Complete NM-Q1 (PPO D-SNP) H0294 — 050 — 0 is a Dual-Eligible Special Needs Type plan. You can only enroll in this plan if you meet specific criteria.
Premium Breakdown
Monthly plan premium
$0.00
Standard Part B premium (estimated)
$209.50
Note:
CMS has not yet announced the official 2027 standard Medicare Part B premium. The estimated 2027 premium is $209.50, per the 2026 Medicare Trustees Report; we'll update this page when CMS publishes the final amount. Your actual Part B premium may differ based on income (IRMAA), late enrollment penalties, Medicaid assistance, disability status, or other factors. Most people enrolled in Medicare Part B are required to pay this premium.
Special needs plan type
Yes
Out-of-pocket maximum (In-Network)
$9850.00
Out-of-pocket maximum (Out-of-Network)
Not applicable
Out-of-pocket maximum (Combined)
$14800.00
Conditions Covered
None
Plan Organization:
Unitedhealthcare Insurance Company
Parent Company:
UnitedHealth Group, Inc.
Plan Type:
PPO D-SNP
Location:
State of New Mexico
Drugs Covered:
Yes
Drug Formulary:
Pharmacies:
Doctors Link:
Deductibles
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Health deductible
Same as Medicare's Part B deductible
Drug deductible
$75
Note:
This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs in certain tiers.
Sign up for UHC Dual Complete NM-Q1 (PPO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
UHC Dual Complete NM-Q1 (PPO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Benefit Type
Enhanced Alternative
Prescription drug deductible
$75.00
Part D Premium Reduction
This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.
Part D | LIS Full |
|---|---|
$0.00 | $0.00 |
Initial Coverage Phase
After you meet any applicable drug deductible ($75.00 for this plan), you pay the plan's cost sharing until your out-of-pocket costs for covered Part D drugs, including certain payments made on your behalf, reach $2,400 in 2027. You then enter catastrophic coverage and pay nothing for covered Part D drugs for the rest of the calendar year.
Tier | Preferred Pharmacy | Standard Pharmacy | Preferred Mail | Standard Mail |
|---|---|---|---|---|
1. Preferred Generic | - | $0.00 copay | - | - |
2. Generic | - | $0.00 copay | - | - |
3. Preferred Brand | - | 25% coinsurance | - | - |
4. Non-Preferred Drug | - | 25% coinsurance | - | 25% coinsurance |
5. Specialty Tier | - | 32% coinsurance | - | 32% coinsurance |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,400, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
UHC Dual Complete NM-Q1 (PPO D-SNP) also provides the following benefits.
Inpatient Hospital
Inpatient Hospital benefits are covered.
Inpatient Hospital-Acute
Inpatient Hospital-Acute benefits are covered.
More Details:
Copayment for Medicare-covered stay
1600.00
Additional Days for Inpatient Hospital-Acute
Additional Days for Inpatient Hospital-Acute benefits are covered.
| Days 91-999: | |
|---|---|
| Copayment | 0.00 |
Non-Medicare-covered Stay for Inpatient Hospital-Acute
Not covered.
Upgrades for Inpatient Hospital-Acute
Not covered.
Inpatient Hospital Psychiatric
Inpatient Hospital Psychiatric benefits are covered.
More Details:
Copayment for Medicare-covered stay
1600.00
Additional Days for Inpatient Hospital Psychiatric
Not covered.
Non-Medicare-covered Stay for Inpatient Hospital Psychiatric
Not covered.
Outpatient Services
Outpatient Services benefits are covered.
All Outpatient Hospital Services
All Outpatient Hospital Services benefits are covered.
Outpatient Hospital Services
Outpatient Hospital Services benefits are covered.
Cost Sharing:
Observation Services
Observation Services benefits are covered.
Cost Sharing:
Ambulatory Surgical Center (ASC) Services
Ambulatory Surgical Center (ASC) Services benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Outpatient Substance Abuse Services
Not covered.
Individual Sessions for Outpatient Substance Abuse
Individual Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Group Sessions for Outpatient Substance Abuse
Group Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Outpatient Blood Services
Outpatient Blood Services benefits are covered.
Cost Sharing:
Partial Hospitalization
Partial Hospitalization benefits are covered.
Partial Hospitalization
Partial Hospitalization benefits are covered.
Cost Sharing:
Partial Hospitalization
Partial Hospitalization benefits are covered.
Cost Sharing:
Ambulance and Transportation Services
Ambulance and Transportation Services benefits are covered.
All Ambulance Services
All Ambulance Services benefits are covered.
Ground Ambulance Services
Ground Ambulance Services benefits are covered.
Cost Sharing:
Air Ambulance Services
Air Ambulance Services benefits are covered.
Cost Sharing:
Transportation Services
Transportation Services benefits are covered.
Cost Sharing:
Transportation Services - Plan Approved Health-related Location
Transportation Services - Plan Approved Health-related Location benefits are covered.
More Details:
Number of trips
24
Description
Car or livery Service
Transportation Services - Any Health-related Location
Not covered.
Emergency Services
Emergency Services benefits are covered.
Emergency Services
Emergency Services benefits are covered.
Cost Sharing:
More Details:
Enter number of days or hours
24
Urgently Needed Services
Urgently Needed Services benefits are covered.
Cost Sharing:
Worldwide Emergency Services
Not covered.
Worldwide Emergency Coverage
Not covered.
Worldwide Urgent Coverage
Not covered.
Worldwide Emergency Transportation
Not covered.
Primary Care
Primary Care benefits are covered.
Primary Care Physician Services
Primary Care Physician Services benefits are covered.
Cost Sharing:
Chiropractic Services
Chiropractic Services benefits are covered.
Cost Sharing:
Routine Chiropractic Care
Not covered.
Occupational Therapy Services
Occupational Therapy Services benefits are covered.
Cost Sharing:
Physician Specialist Services
Physician Specialist Services benefits are covered.
Cost Sharing:
Mental Health Specialty Services
Not covered.
Individual Sessions for Mental Health Specialty Services
Individual Sessions for Mental Health Specialty Services benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Group Sessions for Mental Health Specialty Services
Group Sessions for Mental Health Specialty Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Podiatry Services
Podiatry Services benefits are covered.
More Details:
Enhanced benefits (7f)
Routine Foot Care
Visits
4
Minimum coinsurance
20
Maximum coinsurance
20
Minimum copayment
0.00
Maximum copayment
0.00
Other Health Care Professional
Other Health Care Professional benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Psychiatric Services
Not covered.
Individual Sessions for Psychiatric Services
Individual Sessions for Psychiatric Services benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Group Sessions for Psychiatric Services
Group Sessions for Psychiatric Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Physical Therapy and Speech-Language Pathology Services
Physical Therapy and Speech-Language Pathology Services benefits are covered.
Cost Sharing:
Additional Telehealth Benefits
Not covered.
Opioid Treatment Program Services
Opioid Treatment Program Services benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Preventive Services
Preventive Services benefits are covered.
Medicare-covered Zero Dollar Preventive Services
Medicare-covered Zero Dollar Preventive Services benefits are covered.
Annual Physical Exam
Annual Physical Exam benefits are covered.
Cost Sharing:
Additional Preventive Services
Not covered.
Health Education
Not covered.
In-Home Safety Assessment
Not covered.
Personal Emergency Response System (PERS)
Not covered.
Medical Nutrition Therapy (MNT)
Not covered.
Post discharge In-Home Medication Reconciliation
Not covered.
Re-admission Prevention
Not covered.
Wigs for Hair Loss Related to Chemotherapy
Not covered.
Weight Management Programs
Weight Management Programs benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Alternative Therapies
Not covered.
Therapeutic Massage
Not covered.
Adult Day Health Services
Not covered.
Nutritional/Dietary Benefit
Not covered.
Home-Based Palliative Care
Not covered.
In-Home Support Services
In-Home Support Services benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Support for Caregivers of Enrollees
Support for Caregivers of Enrollees benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Additional Sessions of Smoking and Tobacco Cessation Counseling
Not covered.
Fitness Benefit
Fitness Benefit benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Enhanced Disease Management
Not covered.
Telemonitoring Services
Not covered.
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
Not covered.
Home and Bathroom Safety Devices and Modifications
Home and Bathroom Safety Devices and Modifications benefits are covered.
More Details:
Maximum copayment
0.00
Minimum copayment
0.00
Counseling Services
Not covered.
Kidney Disease Education Services
Kidney Disease Education Services benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Other Preventive Services
Other Preventive Services benefits are covered.
Glaucoma Screening
Glaucoma Screening benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Diabetes Self-Management Training
Diabetes Self-Management Training benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Digital Rectal Exams
Digital Rectal Exams benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
EKG following Welcome Visit
EKG following Welcome Visit benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Hearing Services
Hearing Services benefits are covered.
Hearing Exams
Hearing Exams benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Routine Hearing Exams
Routine Hearing Exams benefits are covered.
More Details:
Number of visits
1
Minimum copayment
0.00
Maximum copayment
0.00
Fitting/Evaluation for Hearing Aid
Not covered.
Prescription Hearing Aids
Prescription Hearing Aids benefits are covered.
More Details:
Maximum amount
2200.00
Prescription Hearing Aids (all types)
Prescription Hearing Aids (all types) benefits are covered.
More Details:
Quantity for Hearing Aids
2
Minimum copayment
0.00
Maximum copayment
0.00
Prescription Hearing Aids - Inner Ear
Not covered.
Prescription Hearing Aids - Outer Ear
Not covered.
Prescription Hearing Aids - Over the Ear
Not covered.
OTC Hearing Aids
Not covered.
Vision Services
Vision Services benefits are covered.
Eye Exams
Eye Exams benefits are covered.
Cost Sharing:
Routine Eye Exams
Routine Eye Exams benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Eyewear
Eyewear benefits are covered.
Cost Sharing:
More Details:
Combined maximum amount
250.00
Contact Lenses
Contact Lenses benefits are covered.
Cost Sharing:
Eyeglasses (lenses and frames)
Eyeglasses (lenses and frames) benefits are covered.
Cost Sharing:
More Details:
Number of eyeglasses
1
Eyeglass lenses
Not covered.
Eyeglass frames
Not covered.
Upgrades
Not covered.
Dental Services
Dental Services benefits are covered.
Medicare Dental Services
Medicare Dental Services benefits are covered.
Cost Sharing:
More Details:
Coinsurance percentage
20
Other Dental Services
Other Dental Services benefits are covered.
More Details:
Maximum amount
1500.00
Oral Exams
Oral Exams benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Periodicity varies by service ranging from 2 every year to 1 every 3 years.
Dental X-Rays
Dental X-Rays benefits are covered.
Cost Sharing:
More Details:
Number of X-Rays
1
Description
Periodicity varies by service ranging from 1 per 60 floating months to 8 every year.
Other Diagnostic Dental Services
Other Diagnostic Dental Services benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Periodicity varies by service ranging from 1 per floating 60 months to 1 per floating day.
Prophylaxis (Cleaning)
Prophylaxis (Cleaning) benefits are covered.
Cost Sharing:
More Details:
Number of visits
2
Fluoride Treatment
Fluoride Treatment benefits are covered.
Cost Sharing:
More Details:
Number of visits
2
Other Preventive Dental Services
Other Preventive Dental Services benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Periodicity varies by service ranging from 1 per floating 36 months to 2 per floating 12 months.
Orthodontic Services
Not covered.
Restorative Services
Restorative Services benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Periodicity varies by service ranging from 1 per lifetime to unlimited.
Adjunctive General Services
Adjunctive General Services benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Periodicity varies by service ranging from 1 per plan year to unlimited.
Endodontics
Endodontics benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Periodicity varies by service ranging from 1 per lifetime to unlimited.
Periodontics
Periodontics benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Periodicity varies by service ranging from 1 per lifetime to 4 per year.
Prosthodontics, removable
Prosthodontics, removable benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Periodicity varies by service ranging from 1 per lifetime to 2 per year.
Maxillofacial Prosthetics
Maxillofacial Prosthetics benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Periodicity varies by service ranging from 1 per floating 60 months to unlimited.
Implant Services
Not covered.
Prosthodontics, fixed
Prosthodontics, fixed benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Recement or re-bond fixed partial denture: 1 per year Fixed partial denture repair: 1 per floating 24 months All other services: 1 every 5 years
Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery benefits are covered.
Cost Sharing:
More Details:
Number of visits
1
Description
Periodicity varies by service ranging from 1 per lifetime to unlimited.
Orthodontics
Not covered.
Home Infusion bundled Services
Not covered.
Dialysis Services
Dialysis Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Medical Equipment
Medical Equipment benefits are covered.
Durable Medical Equipment (DME)
Durable Medical Equipment (DME) benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Prosthetics/Medical Supplies - Non-Medicare benefit
Not covered.
Prosthetic Devices
Prosthetic Devices benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Medical Supplies
Medical Supplies benefits are covered.
Cost Sharing:
Diabetic Equipment
Not covered.
Diabetic Supplies
Diabetic Supplies benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Diabetic Therapeutic Shoes/Inserts
Diabetic Therapeutic Shoes/Inserts benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Diabetic Equipment
Diabetic Equipment benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Diagnostic and Radiological Services
Diagnostic and Radiological Services benefits are covered.
All Diagnostic services
Not covered.
Diagnostic Procedures/Tests
Diagnostic Procedures/Tests benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Lab Services
Lab Services benefits are covered.
Cost Sharing:
All Radiological Services
Not covered.
Diagnostic Radiological Services
Diagnostic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
0
Therapeutic Radiological Services
Therapeutic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Outpatient X-Ray Services
Outpatient X-Ray Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Home Health Services
Home Health Services benefits are covered.
Cost Sharing:
Cardiac Rehabilitation Services
Not covered.
Skilled Nursing Facility (SNF)
Not covered.
Other Services
Other Services benefits are covered.
Acupuncture
Not covered.
Over-the-Counter (OTC) Items
Over-the-Counter (OTC) Items benefits are covered.
Cost Sharing:
More Details:
Attestation
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
Meal Benefit
Not covered.
Dual Eligible SNPs with Highly Integrated Services
Not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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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