UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)

Medicare Plan Details (2023 Plan)

Monthly Premium

by UnitedHealthcare

Additional Coverage

HearingVisionDental

Overall Government Star Rating

4.5

out of 5 stars

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Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

Monthly Premium

$40

Health Portion of Premium

Drug Portion of Premium

$40

Health Plan Deductible

Health Plan Max Out-of-Pocket

$3,900 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

http://UHCCommunityPlan.com

Plan Link

http://UHCCommunityPlan.com

Doctor Services

Primary doctor visit

In-network: $0 copay
Out-of-network: No Data

Specialist visit

In-network: $0 or $35 copay per visit
Out-of-network: No Data

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $0 or $20 copay
Out-of-network: No Data

Lab services

In-network: $0 copay
Out-of-network: No Data

Diagnostic radiology services (like MRI)

In-network: $0 or $0-150 copay
Out-of-network: No Data

Outpatient x-rays

In-network: $0 or $15 copay
Out-of-network: No Data

Emergency care

$0 or $90 copay per visit (always covered)

Urgent care

$0 or $40 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: $0 or $350 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: Not Applicable

Outpatient hospital coverage

In-network: $0 or $0-325 copay per visit
Out-of-network: No Data

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$0 or $196 per day for days 21 through 40
$0 per day for days 41 through 100
Out-of-network: Not Applicable

Preventive services

In-network: $0 copay
Out-of-network: No Data

Ambulance

Ground ambulance

In-network: $0 or $250 copay
Out-of-network: No Data

Therapy services

Occupational therapy visit

In-network: $0 or $30 copay
Out-of-network: No Data

Physical therapy & speech & language therapy visit

In-network: $0 or $30 copay
Out-of-network: No Data

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $0 or $15 copay
Out-of-network: No Data

Outpatient individual therapy with a psychiatrist

In-network: $0 or $25 copay
Out-of-network: No Data

Outpatient group therapy visit

In-network: $0 or $15 copay
Out-of-network: No Data

Outpatient individual therapy visit

In-network: $0 or $25 copay
Out-of-network: No Data

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 0% or 20% coinsurance per item
Out-of-network: No Data

Prosthetics (like braces, artificial limbs)

In-network: 0% or 20% coinsurance per item
Out-of-network: No Data

Diabetes supplies

In-network: $0 copay per item
Out-of-network: No Data

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Tiers	Gap coverage phase	Catastrophic coverage phase
Preferred Generic	Generic drugs : 25% Brand-name drugs : 25%	Generic drugs : $4.15 copay or 5% (whichever costs more) Brand-name drugs : $10.35 copay or 5% (whichever costs more)
Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs

In-network: 0% or 20% coinsurance
Out-of-network: No Data

Other Part B drugs

In-network: 0% or 20% coinsurance
Out-of-network: No Data

Hearing

Hearing exam

In-network: $0 copay
Out-of-network: No Data

Fitting/evaluation

Not covered

Hearing aids - All types

In-network: $0 copay
Out-of-network: No Data