UHC Dual Complete IN-D001 (PPO D-SNP)

by UnitedHealthcareⓇ

2026 Medicare-Medicaid Dual Eligible D-SNP plan available in Indiana

Plan ID H2385-002-0

Additional coverage:

RxHearingVisionDental

Medicare-Medicaid Dual Eligible D-SNP PPO

Monthly plan premium $38 / mo

Annual deductible $0 / yr

Max out-of-pocket · in-network $9,250 / yr

Drug deductible $615 / yr

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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 the in-network doctors who accept the plan and whether a referral is needed.

Plan Name UHC Dual Complete IN-D001 (PPO D-SNP)

Insurance Carrier UnitedHealthcareⓇ

Plan Type Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)

Network Type PPO

Cost Summary

UHC Dual Complete IN-D001 (PPO D-SNP) has a monthly premium cost of $38 per month, with an annual deductible of $0 or $283 per year for some in-network and out-of-network services. and a maximum out-of-pocket cost sharing of $9,250. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $38 / mo

Health portion of premium $0

Drug portion of premium $38

Annual Deductible $0 or $283 per year for some in-network and out-of-network services. / yr

Max Out-of-Pocket · in-network $9,250 / yr

Primary doctor visit 0%-20% coinsurance

Specialist visit 0%-20% coinsurance

ER visit $115 copay

Ambulance 20% coinsurance

Additional Benefits and Coverage

UHC Dual Complete IN-D001 (PPO D-SNP) is a Medicare Advantage plan which includes 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.

Part D Prescription Drug Coverage Yes

Dental Yes

Vision Yes

Hearing Yes

Nationwide Coverage No

Other benefits

Fitness benefit Limited coverage

Over-the-counter drug benefits Limited coverage

In-home support services Limited coverage

Home & bathroom safety devices Limited coverage

Meals for short duration Limited coverage

Annual physical exams Limited coverage

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance

Specialist visit In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance

Tests, labs & imaging

Diagnostic tests & procedures In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Lab services In-network: $0 copay
Out-of-network: $0 copay

Diagnostic radiology services (like MRI) In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance

Outpatient x-rays In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Emergency care $115 copay

Urgent care $0-$40 copay

Hospital Services

Inpatient hospital coverage In-network:
  Tier 1
  $2165 per stay
Out-of-network:
  $2165 per stay

Outpatient hospital coverage In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance

Skilled nursing facility

Skilled nursing facility In-network:
  Tier 1
  $0 per day for days 1-20
  $217 per day for days 21-100
Out-of-network:
  $0 per day for days 1-20
  $217 per day for days 21-100

Preventive services

Preventive services In-network: $0 copay
Out-of-network: 0%-40% coinsurance

Ambulance

Ground ambulance In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Therapy services

Occupational therapy visit In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Physical therapy & speech & language therapy visit In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Outpatient individual therapy with a psychiatrist In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance

Outpatient group therapy visit In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Outpatient individual therapy visit In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Diabetes supplies In-network: $0 copay
Out-of-network: 20% coinsurance

Prescription drugs (Part D benefits)

Drug tier standard retail · 1-month supply Initial coverage Catastrophic

Preferred Generic $0.00 copay $0 copay

Generic 25% coinsurance $0 copay

Preferred Brand 25% coinsurance $0 copay

Non-Preferred Drug 25% coinsurance $0 copay

Specialty Tier 25% coinsurance $0 copay

Part B drugs

Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance

Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance

Extra Benefits

Hearing

Hearing exam In-network: $0 copay
Out-of-network: 30% coinsurance

Fitting/evaluation Not covered

Hearing aids - prescription In-network: $0 copay
Out-of-network: $0 copay

Hearing aids - over the counter In-network: $0 copay
Out-of-network: $0 copay

Preventive dental

Oral exam In-network: $0 copay
Out-of-network: $0 copay

Cleaning In-network: $0 copay
Out-of-network: $0 copay

Fluoride treatment In-network: $0 copay
Out-of-network: $0 copay

Dental x-rays In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services Not covered

Endodontics Not covered

Periodontics Not covered

Prosthodontics, removable Not covered

Prosthodontics, fixed Not covered

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery Not covered

Orthodontics Not covered

Adjunctive general services Not covered

Vision

Routine eye exam In-network: $0 copay
Out-of-network: 30% coinsurance

Contact lenses In-network: $0 copay
Out-of-network: $0 copay

Eyeglasses (frames & lenses) Not covered

Eyeglass frames (only) In-network: $0 copay
Out-of-network: $0 copay

Eyeglass lenses (only) In-network: $0 copay
Out-of-network: $0 copay

Upgrades Not covered

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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