UHC Dual Complete WA-D001 (PPO D-SNP) H0271-044 2024 Plan Details and Costs (2024)

UHC Dual Complete WA-D001 (PPO D-SNP) H0271-044 2024 Plan Details and Costs (1)

UHC Dual Complete WA-D001 (PPO D-SNP) H0271-044 Plan Details

4 out of 5 stars

UHC Dual Complete WA-D001 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H0271-044

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Talk to a licensed agent today to find a plan that fits your needs.

$0.00

Monthly Premium

UHC Dual Complete WA-D001 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H0271-044

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Get Medicare Help

UHC Dual Complete WA-D001 (PPO D-SNP) H0271-044 2024 Plan Details and Costs (2)

UHC Dual Complete WA-D001 (PPO D-SNP) H0271-044 Plan Details

4 out of 5 stars

UHC Dual Complete WA-D001 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H0271-044

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Get Medicare Help

$0.00

Monthly Premium

Washington Counties Served

Douglas Yakima Clark Cowlitz Kitsap King Spokane Lewis Lincoln Garfield Mason Umatilla Columbia Pend Oreille Kittitas Wahkiakum Pierce Jefferson Thurston Snohomish Whatcom Skagit Island Walla Walla Benton Benewah Franklin Pacific Whitman Asotin San Juan

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $8850
Out-of-Network: N/A
Initial Coverage Limit $5030
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit

In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0.00

Out-of-Network:

Doctor Office Visit:
Coinsurance for Medicare Covered Primary Care Office Visit 30%

Specialty Doctor Visit

In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $0.00
Prior Authorization Required for Doctor Specialty Visit
Prior authorization required

Out-of-Network:

Doctor Specialty Visit:
Coinsurance for Medicare Covered Physician Specialist Office Visit 30%

Inpatient Hospital Care

In-Network:

Acute Hospital Services:
Copayment for Acute Hospital Services per Stay $0.00
Your plan covers an unlimited number of days for an inpatient stay.
Prior Authorization Required for Acute Hospital Services
Prior authorization required

Out-of-Network:
Copayment for Acute Hospital Services per Stay $0.00

Urgent Care

Copayment for Urgent Care $0.00

Benefit Details - General 4b Note - NOTE ON COST SHARING RANGE FOR URGENTLY NEEDED SERVICES: $0 copayment applies to Medicare covered telehealth. The higher cost share applies to all other Medicare covered services.

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $0.00

Emergency Room Visit

Copayment for Emergency Care $0.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $0.00
Copayment for Worldwide Emergency Transportation $0.00

Ambulance Transportation

In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $0.00

Air Ambulance:
Copayment for Air Ambulance Services $0.00

Benefit Details - General 10a Note - NOTE ON AUTHORIZATION: Authorization is required for Non-emergency Medicare-covered ambulance ground and air transportation. Emergency Ambulance does not require authorization.
Please see Evidence of Coverage for Prior Authorization rules
Prior authorization required

Out-of-Network:

Ambulance Services:
Coinsurance for Medicare Covered Ambulance Services - Ground 20%
Coinsurance for Medicare Covered Ambulance Services - Air 20%

Health Care Services and Medical Supplies

UHC Dual Complete WA-D001 (PPO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services

In-Network:
Copayment for Medicare-covered Chiropractic Services $0.00
Copayment for Routine Care $0.00

  • Maximum 12 Routine Care every year

Prior Authorization Required for Chiropractic Services
Prior authorization required

Out-of-Network:
Coinsurance for Medicare Covered Chiropractic Services 30% Coinsurance for Non-Medicare Covered Chiropractic Services 30%

Diabetes Supplies, Training, Nutrition Therapy and Monitoring

In-Network:
Copayment for Medicare-covered Diabetic Supplies $0.00
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0.00
Prior Authorization Required for Diabetic Supplies and Services
Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage)
Prior authorization required

Out-of-Network:
Coinsurance for Medicare Covered Diabetic Supplies and Services 30%

Durable Medical Eqipment (DME)

In-Network:
Copayment for Medicare-covered Durable Medical Equipment $0.00
Prior Authorization Required for Durable Medical Equipment
Prior authorization required

Out-of-Network:
Coinsurance for Medicare Covered Durable Medical Equipment 30%

Diagnostic Tests, Lab and Radiology Services, and X-Rays

In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0.00
Copayment for Medicare-covered Lab Services $0.00
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $0.00
Copayment for Medicare-covered Therapeutic Radiological Services $0.00
Copayment for Medicare-covered X-Ray Services $0.00
Prior Authorization Required for Outpatient Diag/Therapeutic Rad Services
Prior authorization required

Out-of-Network:

Outpatient Diag Procs/Tests/Lab Services:
Coinsurance for Medicare Covered Diagnostic Procedures/Tests 30%
Copayment for Medicare Covered Lab Services $0.00
Coinsurance for Medicare Covered Diagnostic Radiological Services 30%
Coinsurance for Medicare Covered Therapeutic Radiological Services 30%
Coinsurance for Medicare Covered Outpatient X-Ray Services 30%

Home Health Care

In-Network:
Copayment for Medicare-covered Home Health Services $0.00
Prior Authorization Required for Home Health Services
Prior authorization required

Out-of-Network:
Coinsurance for Medicare Covered Home Health 30%

Mental Health Inpatient Care

In-Network:

Psychiatric Hospital Services:
Copayment for Psychiatric Hospital Services per Stay $0.00
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required

Out-of-Network:
Copayment for Psychiatric Hospital Services per Stay $0.00

Mental Health Outpatient Care

In-Network:
Copayment for Medicare-covered Individual Sessions $0.00
Copayment for Medicare-covered Group Sessions $0.00
Prior Authorization Required for Outpatient Mental Health Services
Prior authorization required

Out-of-Network:
Coinsurance for Medicare Covered Individual Sessions 30%
Coinsurance for Medicare Covered Group Sessions 30%

Outpatient Services / Surgery

In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0.00
Prior Authorization Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services $0.00
Prior Authorization Required for Outpatient Observation Services

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0.00
Prior Authorization Required for Ambulatory Surgical Center Services
Prior authorization required

Out-of-Network:

Outpatient Hospital and ASC Services:
Coinsurance for Medicare Covered Outpatient Hospital Services 30%
Coinsurance for Medicare Covered Ambulatory Surgical Center Services 30%

Outpatient Substance Abuse Care

In-Network:
Copayment for Medicare-covered Individual Sessions $0.00
Copayment for Medicare-covered Group Sessions $0.00
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required

Out-of-Network:
Coinsurance for Medicare Covered Individual or Group Sessions 30%

Over-the-counter (OTC) Items

In-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $159.00 every month
Nicotine Replacement Therapy (NRT) offerred as a Part C OTC benefit

Out-of-Network:

Over-The-Counter (OTC) Items:
Copayment for Non-Medicare Covered Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $159.00

Podiatry Services

In-Network:
Copayment for Medicare-Covered Podiatry Services $0.00
Copayment for Routine Foot Care $0.00

  • Maximum 4 visits every year

Prior Authorization Required for Podiatry Services
Prior authorization required

Out-of-Network:
Coinsurance for Medicare Covered Podiatry Services 30% Coinsurance for Non-Medicare Covered Podiatry Services 30%

Skilled Nursing Facility Care

In-Network:

Skilled Nursing Facility Services:
$0.00 per day for days 1 to 20
$0.00 per day for days 21 to 100
Prior Authorization Required for Skilled Nursing Facility Services
Prior authorization required

Out-of-Network:
Copayment for Skilled Nursing Facility Services per Stay $0.00

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care

In-Network:

Preventive Dental:
Copayment for Oral Exams $0.00

  • Maximum 2 visits every year

Copayment for Prophylaxis (Cleaning) $0.00

  • Maximum 3 visits every year

Copayment for Fluoride Treatment $0.00

  • Maximum 2 visits every year

Copayment for Dental X-Rays $0.00

  • Maximum 1 visit (Please see Evidence of Coverage for details)

Maximum Plan Benefit of $3000.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined

Comprehensive Dental:
Copayment for Medicare-covered Benefits $0.00
Copayment for Non-routine Services $0.00
Copayment for Diagnostic Services $0.00

  • Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Restorative Services $0.00

  • Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Endodontics $0.00

  • Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Periodontics $0.00

  • Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Extractions $0.00

  • Maximum 1 visit (Please see Evidence of Coverage for details)

Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00

  • Maximum 1 visit (Please see Evidence of Coverage for details)

Maximum Plan Benefit of $3000.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined
Prior Authorization Required for Comprehensive Dental
Prior authorization required

Out-of-Network:

Medicare Covered Dental Services:
Coinsurance for Medicare Covered Comprehensive Dental 30%
Non-Medicare Covered Dental Services:
Copayment for Non-Medicare Covered Preventive Dental $0.00
Copayment for Non-Medicare Covered Comprehensive Dental $0.00

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits

In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0.00
Copayment for Routine Eye Exams $0.00

  • Maximum 1 Routine Eye Exam every year

Prior Authorization Required for Eye Exams

Eyewear:
Copayment for Medicare-Covered Benefits $0.00
Copayment for Contact Lenses $0.00
Copayment for Eyeglasses (lenses and frames) $0.00

  • Maximum 1 Pair every year

Maximum Plan Benefit of $300.00 every year for all Non-Medicare covered eyewear for in and out of network services combined
Prior authorization required

Out-of-Network:

Medicare Covered Vision Services:
Coinsurance for Medicare Covered Eye Exams 30%
Coinsurance for Medicare Covered Eyewear 30%
Non-Medicare Covered Vision Services:
Coinsurance for Non-Medicare Covered Eye Exams 30%
Copayment for Non-Medicare Covered Eyewear $0.00

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits

In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $0.00
Copayment for Routine Hearing Exams $0.00

  • Maximum 1 visit every year

Prior Authorization Required for Hearing Exams

Hearing Aids:
Copayment for Hearing Aids $0.00

  • Maximum 2 Hearing Aids every year

Maximum Plan Benefit of $1100.00 every year both ears combined for in and out of network services combined
Prior Authorization Required for Hearing Aids
Prior authorization required

Out-of-Network:

Medicare Covered Hearing Services:
Coinsurance for Medicare Covered Hearing Exams 30%
Non-Medicare Covered Hearing Services:
Coinsurance for Non-Medicare Covered Hearing Exams 30%
Copayment for Non-Medicare Covered Hearing Aids $0.00

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs

In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:

  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
  • Tobacco use cessation
    Yearly "Wellness" visit

    Out-of-Network:

    Medicare-covered Zero Dollar Preventive Services:
    Coinsurance for Medicare Covered Medicare-covered Preventive Services 0% to 30%

    Prescription Drug Costs and Coverage

    The UHC Dual Complete WA-D001 (PPO D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $0 per year.

    Coverage

    Cost

    Coverage & Cost

    Annual Drug Deductible $0
    Preferred Generic
    • Standard retail $0.00
    • Preferred cost-share mail order N/A
    • Standard mail order N/A
    Generic
    • Standard retail $0.00
    • Preferred cost-share mail order N/A
    • Standard mail order N/A
    Annual Drug Deductible $0
    Preferred Generic
    • Standard retail N/A
    • Preferred cost-share mail order N/A
    • Standard mail order N/A
    Generic
    • Standard retail N/A
    • Preferred cost-share mail order N/A
    • Standard mail order N/A
    Annual Drug Deductible $0
    Preferred Generic
    • Standard retail $0.00
    • Preferred cost-share mail order $0.00
    • Standard mail order $0.00
    Generic
    • Standard retail $0.00
    • Preferred cost-share mail order $0.00
    • Standard mail order $0.00

    Back to Plans in Washington

    UHC Dual Complete WA-D001 (PPO D-SNP) H0271-044 2024 Plan Details and Costs (2024)

    FAQs

    What does UHC dual complete plan mean? ›

    UHC Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. These SNP plans provide benefits beyond Original Medicare, such as transportation to medical appointments and routine vision exams.

    What does UHC PPO stand for? ›

    UnitedHealthcare Non-differential Preferred Provider Organization (PPO)

    What is the difference between United Healthcare Choice Plus and PPO? ›

    The United Healthcare (UHC) Choice Plus plan is a PPO plan that allows you to see any doctor in their network – including specialists – without a referral. United Healthcare has a national network of providers; however, you may use any licensed provider you choose. There are two levels of coverage under the plan.

    What is a PPO DSNP? ›

    DSNPs are specialized Medicare Advantage plans that provide healthcare benefits for beneficiaries that have both Medicare and Medicaid coverage. Most DSNPs are categorized as either HMOs (Health Maintenance Organization plans) or PPOs (Preferred Provider Organization plans).

    What is the difference between D-SNP and C SNP? ›

    Like a D-SNP, a Chronic Condition Special Needs Plan (C-SNP) is a type of SNP. While D-SNPs are for people with both Medicare and Medicaid eligibility, C-SNPs are designed for people who have a specific chronic or disabling condition (e.g., diabetes or heart disease).

    What does dual insurance mean? ›

    Whenever you make a health insurance claim, your primary insurance plan will act as if you had no secondary plan and provide you with your benefits. Then your secondary insurance plan kicks in and covers the rest of the cost if it's covered and necessary.

    Which is better a PPO or HMO? ›

    HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

    What is the difference between HMO and PPO UnitedHealthcare? ›

    HMO PlansWith most plans, you'll need to choose a PCP. This PCP is your main health care contact and care is often coordinated through them. You may need to get a referral from your PCP to see a specialist. PPO PlansIt's less likely that you'd need to choose a PCP and less likely to need a referral to see a specialist.

    What does PPO stand for in health insurance? ›

    Preferred provider organization (PPO) A type of medical plan in which coverage is provided to participants through a network of selected health care providers, such as hospitals and physicians.

    What is the deductible for United Healthcare in 2024? ›

    Annual medical deductible Your medical deductible is $0 or $240 combined in and out-of-network for covered medical services you receive from providers.

    How to tell if your insurance is PPO or HMO? ›

    However, if you've already got a health plan and don't know which plan type you have, you can check your insurance card or contact your insurance provider directly. If you have an online account through your provider that allows you to access plan details, you can also start there.

    What is the difference in a PPO and Advantage plan? ›

    HMO Costs. Essentially, Medicare Advantage HMO and PPO plans have around the same costs covered for essential medical services. This includes copayments, coinsurance, deductibles, and your monthly premium and Part B premium. However, HMO plans usually have lower monthly premiums than PPO plans.

    What are the two types of PPOs? ›

    There are two types of Medicare PPO plan: Regional PPOs, which serve a single state or multi-state areas determined by Medicare. Local PPOs, which serve a single county or group of counties chosen by the plan and approved by Medicare.

    What does D-SNP mean in Medicare? ›

    Dual Special Needs Plans (D-SNP) Contract and Policy Guide​​​​ Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage (MA) health plans which provide specialized care and wrap-around services for dual eligible beneficiaries (eligible for both Medicare and ​Medicaid).

    Why do people say not to get a Medicare Advantage plan? ›

    Restrictive networks

    In some cases, you'll have a higher share of costs when you see an out-of-network doctor. In other cases, you're not covered at all if you go out of network. This is particularly important if you travel a lot because Medicare Advantage plans generally don't provide out-of-state coverage.

    What is a dual benefit? ›

    If you are like more than 12 million people aged 65 or older in the United States who may need extra assistance paying for some or all the costs of your healthcare, you may qualify as a dual-eligible beneficiary. 1 This means that you can receive health benefits through both Medicare and Medicaid.

    Can you have Medicare and UnitedHealthcare at the same time? ›

    UnitedHealthcare Dual Complete plans

    This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

    What items can I buy with my UCard? ›

    Shop for healthy food and OTC products or pay utility bills

    A credit will be loaded to your UnitedHealthcare UCard® every month to help pay for healthy food, over-the-counter (OTC) products, and utility bills. Shop in-store or online to buy covered groceries, pain relievers, cold remedies and more.

    What is the difference between MMP and DSNP? ›

    These plans streamline access to care through Medicare and Medicaid. But there's a key difference. With an MMP, all Medicare and Medicaid benefits are provided through 1 single health plan. With a D-SNP, members keep the same Medicaid plan and all the same Medicaid benefits as they get today.

    References

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