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UHC Dual Complete RI-V001 (HMO-POS D-SNP)

Rhode Island Medicare-Medicaid Dual Eligible D-SNP Plan (2025 Plan)

Monthly Premium

Your Cost
$12
by UnitedHealthcareⓇ

Additional Coverage

HearingVisionDental

Overall Government Star Rating

(coming soon)

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Plan Overview

Plan Name
UHC Dual Complete RI-V001 (HMO-POS D-SNP)
Insurance Carrier
UnitedHealthcareⓇ
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
HMO

UHC Dual Complete RI-V001 (HMO-POS D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Rhode Island and offered by the health insurance company UnitedHealthcareⓇ. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$12
Annual Deductible
$0
Max Out-of-Pocket
$4,900
Primary doctor visit
$0 copay
Specialist visit
$0 or $0-20 copay per visit
ER visit
$0 or $125 copay per visit (always covered)
Ambulance
$0 or $275 copay

UHC Dual Complete RI-V001 (HMO-POS D-SNP) has a monthly premium cost of $12 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $4,900 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 RI-V001 (HMO-POS D-SNP) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

UHC Dual Complete RI-V001 (HMO-POS 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 RI-V001 (HMO-POS D-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. UHC Dual Complete RI-V001 (HMO-POS D-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Limited coverage
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Plan Benefits and Coverage Details

Monthly Premium
$12
Health Portion of Premium
$0
Drug Portion of Premium
$12
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$4,900 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
http://UHC.com/CommunityPlan
Plan Link
http://UHC.com/CommunityPlan

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Specialist visit
In-network: $0 or $0-20 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 or $50 copay
Lab services
In-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $0 or $0-250 copay
Outpatient x-rays
In-network: $0 or $25 copay
Emergency care
$0 or $125 copay per visit (always covered)
Urgent care
$0 or $0-55 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $0 or $395 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
Out-of-network: Not Applicable
Outpatient hospital coverage
In-network: $0 or $0-395 copay per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$0 or $203 per day for days 21 through 100
Out-of-network: Not Applicable

Preventive services

Preventive services
In-network: $0 copay

Ambulance

Ground ambulance
In-network: $0 or $275 copay

Therapy services

Occupational therapy visit
In-network: $0 or $0-20 copay
Physical therapy & speech & language therapy visit
In-network: $0 or $0-20 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $0 or $5 copay
Outpatient individual therapy with a psychiatrist
In-network: $0 or $0-10 copay
Outpatient group therapy visit
In-network: $0 or $5 copay
Outpatient individual therapy visit
In-network: $0 or $0-10 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 0% or 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 0% or 20% coinsurance per item
Diabetes supplies
In-network: $0 copay per item

Prescription Drug Benefits

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

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25% coinsurance

Brand-name drugs :
25% coinsurance


Generic drugs :
0% coinsurance

Brand-name drugs :
0% coinsurance

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
In-network: 0% or 0-20% coinsurance
Other Part B drugs
In-network: 0% or 0-20% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: $0 copay
Fitting/evaluation
Not covered
Hearing aids - All types
In-network: $199-1,249 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
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Prosthodontics, fixed
In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Maxillofacial prosthetics
In-network: $0 copay
Out-of-network: $0 copay
Implant services
Not covered
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
Not covered
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam
In-network: $0 copay
Contact lenses
In-network: $0 copay
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
In-network: $0 copay
Eyeglass lenses (only)
In-network: $0-153 copay
Upgrades
Not covered

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