UHC Dual Complete VA-Y4 (PPO D-SNP)
Virginia Medicare-Medicaid Dual Eligible D-SNP Plan (2025 Plan)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
(coming soon)
Plan Name
UHC Dual Complete VA-Y4 (PPO D-SNP)
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
UHC Dual Complete VA-Y4 (PPO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Virginia 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.
Primary doctor visit
$0 copay
Specialist visit
$0 copay
UHC Dual Complete VA-Y4 (PPO 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 $14,000 In and Out-of-network
$9,350 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 VA-Y4 (PPO D-SNP) are defined below.
Yes
Part D Prescription Drug Coverage
UHC Dual Complete VA-Y4 (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 VA-Y4 (PPO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. UHC Dual Complete VA-Y4 (PPO D-SNP) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
$14,000 In and Out-of-network
$9,350 In-network
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $0 copay
Out-of-network: 40% coinsurance per visit
Specialist visit
In-network: $0 copay
Out-of-network: 40% coinsurance per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: 40% coinsurance
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $0 copay
Out-of-network: 40% coinsurance
Outpatient x-rays
In-network: $0 copay
Out-of-network: 40% coinsurance
Hospital Services
Inpatient hospital coverage
In-network: $0 copay
Out-of-network: $1,565 per stay
Outpatient hospital coverage
In-network: $0 copay
Out-of-network: 40% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
In-network: $0 copay
Out-of-network: 40% per stay
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: 0-40% coinsurance
Ambulance
Ground ambulance
In-network: $0 copay
Out-of-network: 20% coinsurance
Therapy services
Occupational therapy visit
In-network: $0 copay
Out-of-network: 40% coinsurance
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: 40% coinsurance
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $0 copay
Out-of-network: 40% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Out-of-network: 40% coinsurance
Outpatient group therapy visit
In-network: $0 copay
Out-of-network: 40% coinsurance
Outpatient individual therapy visit
In-network: $0 copay
Out-of-network: 40% coinsurance
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: $0 copay
Out-of-network: 40% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: $0 copay
Out-of-network: 40% coinsurance per item
Diabetes supplies
In-network: $0 copay
Out-of-network: 40% coinsurance per item
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Catastrophic 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 copay
Out-of-network: 40% coinsurance
Other Part B drugs
In-network: $0 copay
Out-of-network: 40% coinsurance
Hearing
Hearing exam
In-network: $0 copay
Out-of-network: 40% coinsurance
Hearing aids - All types
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
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 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
In-network: $0 copay
Out-of-network: $0 copay
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: 40% coinsurance
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: $0 copay
When Can I Sign Up for Medicare?
Enter your birthday month and year to learn when you can sign up for different Medicare plan options.
Health Plan Radar