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At UnitedHealthcare, we're here to help you understand what's covered and how to get care related to COVID-19.
UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) is a 2020 Medicare Advantage Special Needs Plan plan by UnitedHealthcare. This plan from UnitedHealthcare works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from UnitedHealthcare and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) DS-H0432 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.
- Here you will find the tools and resources you need to help manage your practice’s submission of claims and receipt of payments. Our self-service resources for claims include using Electronic Data Interchange (EDI) and the Claims tool in UnitedHealthcare provider portal. UnitedHealthcare is launching initiatives to replace paper checks with electronic payments.
- Please use the following cost-sharing information when treating and servicing UnitedHealthcare Medicare Advantage members. If you have questions, contact your Provider Advocate or call Provider Services at 877-842-3210. Benefit Copay and coinsurance guidelines. Alcohol Misuse Counseling.
2020 Medicare Special Needs Plan Details
| Plan Name: | UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) |
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| Plan ID: |
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| Special Needs Type: | Dual-Eligible |
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| Provider: | UnitedHealthcare |
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| Plan Year: | 2020 |
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| Plan Type: | Local HMO |
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| Monthly Premium C+D: | $15.30 |
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The UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) DS-H0432 is available to residents in Alabama, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.
Part-C Premium
UnitedHealthcare plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
The UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) plan has a monthly drug premium of $15.30 and a $435.00 drug deductible. This UnitedHealthcare plan offers a $15.30 Part D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by UnitedHealthcare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $15.30. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Premium Assistance
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $3.80 for 75% low income subsidy $7.60 for 50% and $11.50 for 25%.
| Part C Premium: | $0.00 |
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| Part D (Drug) Premium: | $15.30 |
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| Part D Supplemental Premium | $0.00 |
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| Total Part D Premium: | $15.30 |
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| Drug Deductible: | $435.00 |
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| Tiers with No Deductible: | 0 |
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| Benchmark: | below the regional benchmark |
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| Type of Medicare Health Plan: | Defined Standard Benefit |
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| Drug Benefit Type: | Basic |
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| Full LIS Premium: | $0.00 |
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| 75% LIS Premium: | $3.80 |
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| 50% LIS Premium: | $7.60 |
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| 25% LIS Premium: | $11.50 |
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| Gap Coverage: | No |
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Gap Coverage
In 2020 once you and your plan provider have spent $4020 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for brand-name drugs and 25% on generic drugs unless your plan offers additional coverage. This UnitedHealthcare plan does not offer additional coverage through the gap.
UnitedHealthcare Drug Coverage and Formulary
A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) H0432-009 Formulary here.
See the 2020 UnitedHealthcare Formulary
(*2020 Plan services will be added when available)
Health plan deductible
Emergency care/Urgent care
| Emergency | $0 or $90 per visit (always covered) |
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| Urgent care | $0 or $65 per visit (always covered) |
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Diagnostic procedures/lab services/imaging
| Diagnostic tests and procedures | 0% or 20% |
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| Lab services | $0 |
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| Diagnostic radiology services (e.g., MRI) | 0% or 20% |
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| Outpatient x-rays | 0% or 20% |
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Hearing
| Hearing exam | $0 copay |
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| Fitting/evaluation | Not covered |
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| Hearing aids | $0 copay |
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Preventive dental
| Oral exam | $0 copay |
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| Cleaning | $0 copay |
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| Fluoride treatment | $0 copay |
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| Dental x-ray(s) | $0 copay |
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Comprehensive dental
| Non-routine services | Not covered |
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| Diagnostic services | $0 copay |
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| Restorative services | $0 copay |
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| Endodontics | $0 copay |
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| Periodontics | $0 copay |
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| Extractions | $0 copay |
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| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay |
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Vision
| Routine eye exam | $0 copay |
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| Other | Not covered |
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| Contact lenses | $0 copay |
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| Eyeglasses (frames and lenses) | Not covered |
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| Eyeglass frames | $0 copay |
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| Eyeglass lenses | $0 copay |
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| Upgrades | Not covered |
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Mental health services
| Inpatient hospital - psychiatric | $0 or $500 per stay |
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| Outpatient group therapy visit with a psychiatrist | $0 copay |
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| Outpatient individual therapy visit with a psychiatrist | $0 copay |
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| Outpatient group therapy visit | $0 copay |
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| Outpatient individual therapy visit | $0 copay |
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Skilled Nursing Facility
Rehabilitation services
| Occupational therapy visit | $0 copay |
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| Physical therapy and speech and language therapy visit | $0 copay |
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Ground ambulance
Other health plan deductibles?
Transportation
Unitedhealthcare Chiropractic Copay
Foot care (podiatry services)
| Foot exams and treatment | $0 copay |
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| Routine foot care | $0 copay |
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Medical equipment/supplies
| Durable medical equipment (e.g., wheelchairs, oxygen) | 0% or 20% per item |
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| Prosthetics (e.g., braces, artificial limbs) | 0% or 20% per item |
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| Diabetes supplies | $0 per item |
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Wellness programs (e.g., fitness, nursing hotline)
Medicare Part B drugs
| Chemotherapy | 0% or 20% |
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| Other Part B drugs | 0% or 20% |
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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
Optional supplemental benefits
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
Inpatient hospital coverage
$0 or $500 per stay
$0 per day for days 91 and beyond |
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Outpatient hospital coverage
Doctor visits
| Primary | $0 copay |
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| Specialist | $0 copay |
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Preventive care
Ratings for UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) DS
| 2019 Overall Rating |
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| Part C Summary Rating |
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| Part D Summary Rating |
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| Staying Healthy: Screenings, Tests, Vaccines |
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| Managing Chronic (Long Term) Conditions |
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| Member Experience with Health Plan |
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| Complaints and Changes in Plans Performance |
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| Health Plan Customer Service |
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| Drug Plan Customer Service |
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| Complaints and Changes in the Drug Plan |
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| Member Experience with the Drug Plan |
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| Drug Safety and Accuracy of Drug Pricing |
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Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
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| Breast Cancer Screening |
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| Colorectal Cancer Screening |
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| Annual Flu Vaccine |
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| Improving Physical |
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| Improving Mental Health |
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| Monitoring Physical Activity |
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| Adult BMI Assessment |
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Managing Chronic And Long Term Care for Older Adults
| Total Rating |
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| SNP Care Management |
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| Medication Review |
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| Functional Status Assessment |
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| Pain Screening |
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| Osteoporosis Management |
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| Diabetes Care - Eye Exam |
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| Diabetes Care - Kidney Disease |
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| Diabetes Care - Blood Sugar |
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| Rheumatoid Arthritis |
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| Reducing Risk of Falling |
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| Improving Bladder Control |
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| Medication Reconciliation |
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| Plan All-Cause Readmissions |
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| Statin Therapy |
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Member Experience with Health Plan
| Total Experience Rating |
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| Getting Needed Care |
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| Timely Care and Appointments |
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| Customer Service |
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| Health Care Quality |
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| Rating of Health Plan |
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| Care Coordination |
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Member Complaints and Changes in UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) Plans Performance
| Total Rating |
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| Complaints about Health Plan |
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| Members Leaving the Plan |
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| Health Plan Quality Improvement |
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Health Plan Customer Service Rating for UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)
| Total Customer Service Rating |
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| Timely Decisions About Appeals |
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| Reviewing Appeals Decisions |
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| Call Center, TTY, Foreign Language |
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UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP) Drug Plan Customer Service ratings
| Total Rating |
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| Call Center, TTY, Foreign Language |
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| Appeals Auto |
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| Appeals Upheld |
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Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
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| Complaints about the Drug Plan |
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| Members Choosing to Leave the Plan |
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| Drug Plan Quality Improvement |
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Member Experience with the Drug Plan
| Total Rating |
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| Rating of Drug Plan |
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| Getting Needed Prescription Drugs |
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United Healthcare Specialist Copay System
Drug Safety and Accuracy of Drug Pricing
| Total Rating |
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| MPF Price Accuracy |
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| Drug Adherence for Diabetes Medications |
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| Drug Adherence for Hypertension (RAS antagonists) |
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| Drug Adherence for Cholesterol (Statins) |
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| MTM Program Completion Rate for CMR |
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| Statin with Diabetes |
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Coverage Area for UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)
| State: | Alabama
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| County: | Autauga, Baldwin, Barbour, Bibb,
Blount, Bullock, Calhoun,
Chilton, Clarke, Clay,
Coffee, Colbert, Coosa,
Cullman, Dale, Dallas,
Elmore, Escambia, Geneva,
Henry, Houston, Jefferson,
Lauderdale, Lawrence, Limestone,
Lowndes, Macon, Madison,
Marshall, Mobile, Monroe,
Montgomery, Morgan, Perry,
Russell, Shelby, St. Clair,
Talladega, Tallapoosa, Walker,
Winston, |
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Source: CMS.
Plans as of September 4, 2019.
Uhc Medical Policy Guidelines
Star Rating as of October 11, 2019.
United Healthcare Specialist Copay
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change. All contracts for 2020 have not been finalized. For 2020, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.
Includes 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.
