UHC Dual Advantage MO-V1 (HMO-POS D-SNP)

by UnitedHealthcareⓇ

2027 Medicare-Medicaid Dual Eligible D-SNP plan available in Missouri

Plan ID H0169-015-1

Additional coverage:

RxHearingVisionDental

Medicare-Medicaid Dual Eligible D-SNP HMO $0 premium

Monthly plan premium $0 / mo

Annual deductible $0 / yr

Max out-of-pocket · in-network $7,150 / yr

Drug deductible $700 / yr

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Plan Overview

UHC Dual Advantage MO-V1 (HMO-POS D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Missouri and offered by the health insurance company UnitedHealthcareⓇ. This plan's network type is HMO, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name UHC Dual Advantage MO-V1 (HMO-POS D-SNP)

Insurance Carrier UnitedHealthcareⓇ

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

Network Type HMO

Cost Summary

UHC Dual Advantage MO-V1 (HMO-POS D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $7,150. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $0 / mo

Health portion of premium $0

Drug portion of premium $0

Annual Deductible $0 / yr

Max Out-of-Pocket · in-network $7,150 / yr

Primary doctor visit $0 copay

Specialist visit $0-$75 copay

ER visit $130 copay

Ambulance $350 copay

Additional Benefits and Coverage

UHC Dual Advantage MO-V1 (HMO-POS 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 Advantage MO-V1 (HMO-POS 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 Not covered

Medical Benefits

Doctor Services

Primary doctor visit In-network: $0 copay
Out-of-network: $0 copay

Specialist visit In-network: $0-$75 copay
Out-of-network: $0-$75 copay

Tests, labs & imaging

Diagnostic tests & procedures In-network: $50 copay
Out-of-network: $50 copay

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

Diagnostic radiology services (like MRI) In-network: $0-$380 copay
Out-of-network: $0-$380 copay

Outpatient x-rays In-network: $30 copay
Out-of-network: $30 copay

Emergency care $130 copay

Urgent care $0-$50 copay

Hospital Services

Inpatient hospital coverage In-network:
  Tier 1
  $685 per day for days 1-4
  $0 per day for days 5-90
  $0 per stay

Outpatient hospital coverage In-network: $0-$685 copay
Out-of-network: $0-$685 copay

Skilled nursing facility

Skilled nursing facility In-network:
  Tier 1
  $0 per day for days 1-20
  $221 per day for days 21-100

Preventive services

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

Ambulance

Ground ambulance In-network: $350 copay
Out-of-network: $350 copay

Therapy services

Occupational therapy visit In-network: $50 copay
Out-of-network: $50 copay

Physical therapy & speech & language therapy visit In-network: $75 copay
Out-of-network: $75 copay

Mental health services

Outpatient group therapy with a psychiatrist In-network: $15 copay
Out-of-network: $15 copay

Outpatient individual therapy with a psychiatrist In-network: $0-$25 copay
Out-of-network: $0-$25 copay

Outpatient group therapy visit In-network: $15 copay
Out-of-network: $15 copay

Outpatient individual therapy visit In-network: $0-$25 copay
Out-of-network: $0-$25 copay

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 30% coinsurance
Out-of-network: 30% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 30% coinsurance
Out-of-network: 30% coinsurance

Diabetes supplies In-network: $0 copay
Out-of-network: $0 copay

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: 0%-20% coinsurance

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

Extra Benefits

Hearing

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

Fitting/evaluation Not covered

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

Hearing aids - over the counter Not covered

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: $0 copay

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

Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay

Eyeglass frames (only) Not covered

Eyeglass lenses (only) Not covered

Upgrades Not covered

Plan documents & tools

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

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