UHC Dual Complete IN-D001 (PPO D-SNP)
Indiana Medicare-Medicaid Dual Eligible D-SNP Plan (2024 Plan)
Monthly Premium
Additional Coverage
Overall Government Star Rating
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Plan Overview
UHC Dual Complete IN-D001 (PPO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Indiana and offered by the health insurance company UnitedHealthcare. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
UHC Dual Complete IN-D001 (PPO D-SNP) has a monthly premium cost of $42 per month, with an annual deductible of $0 or $240 per year for some in-network and out-of-network services. and a maximum out of pocket cost sharing of $13,300 In and Out-of-network $8,850 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for UHC Dual Complete IN-D001 (PPO D-SNP) are defined below.
Additional Benefits and Coverage
UHC Dual Complete IN-D001 (PPO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. UHC Dual Complete IN-D001 (PPO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. UHC Dual Complete IN-D001 (PPO D-SNP) includes coverage for the following additional benefits:
Other benefits
Comparing the Quality Score of UHC Dual Complete IN-D001 (PPO D-SNP) to Other Plans in Indiana
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, UHC Dual Complete IN-D001 (PPO D-SNP) received an overall government quality rating of 4.0 stars out of 5 stars.
UHC Dual Complete IN-D001 (PPO D-SNP) performed better than Indiana’s State average overall quality score of 3.6 stars.
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
UHC Dual Complete IN-D001 (PPO D-SNP) received 4 stars for its health plan quality score which is better than the Indiana State average health plan quality score of 3.6 stars.
UHC Dual Complete IN-D001 (PPO D-SNP) received 4.5 stars for its drug plan quality score which is better than the Indiana State average drug plan quality score of 3.5 stars.
Plan Benefits and Coverage Details
$8,850 In-network
Medical Benefits
Doctor Services
Out-of-network: 40% coinsurance per visit
Out-of-network: 40% coinsurance per visit
Tests, labs, & imaging
Out-of-network: 40% coinsurance
Out-of-network: $0 copay
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Hospital Services
$0 per day for days 91 and beyond
Out-of-network: 40% per stay
Out-of-network: 40% coinsurance per visit
Skilled nursing facility
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100
Out-of-network: 40% per stay
Preventive services
Out-of-network: 0-40% coinsurance
Ambulance
Out-of-network: 20% coinsurance
Therapy services
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Mental health services
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Opioid treatment services
Other services
Out-of-network: 40% coinsurance per item
Out-of-network: 40% coinsurance per item
Out-of-network: 40% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic |
Brand-name drugs :
|
Brand-name drugs :
| |
| Generic | |||
| Preferred Brand | |||
| Non-Preferred Drug | |||
| Specialty Tier |
Part B Drugs
Out-of-network: 40% coinsurance
Out-of-network: 40% coinsurance
Extra Benefits
Hearing
Out-of-network: 40% coinsurance
Out-of-network: $0 copay
Preventive Dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Vision
Out-of-network: 40% coinsurance
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
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