UHC Dual Complete MO-S002 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H0271-029
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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 MO-S002 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H0271-029
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
UHC Dual Complete MO-S002 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H0271-029
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
$0.00
Monthly Premium
Missouri Counties Served
Lincoln Osage Saint Louis City Cooper Washington Gasconade Saint Charles Montgomery Crawford Franklin Miller Maries Jefferson Warren Audrain Boone Saint Louis Cole Moniteau Callaway Morgan Johnson Platte Clay Cass Ray Lafayette Jackson Laclede Lawrence Webster Pettis Pike Vernon Ozark Bates Dade Stone Perry Sainte Genevieve Wright Douglas Taney Christian Saint Francois Oregon Barry Dallas Hickory Greene Phelps Saline Henry Carroll Howard Pulaski Howell Benton Bollinger Cedar Polk Saint Clair Camden Mcdonald Jasper Clinton Newton Barton Mississippi New Madrid Sullivan Carter Grundy Caldwell Dunklin Reynolds Andrew Nodaway Atchison Randolph Worth Dekalb Adair Shannon Butler Monroe Texas Daviess Dent Chariton Holt Pemiscot Knox Macon Marion Shelby Linn Stoddard Ralls Gentry Putnam Livingston Ripley Lewis Scotland Mercer Clark Schuyler Wayne Harrison Buchanan Iron Scott Cape Girardeau Madison
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: Out-of-Network: Doctor Office Visit: |
Specialty Doctor Visit | In-Network: Doctor Specialty Visit: Out-of-Network: Doctor Specialty Visit: |
Inpatient Hospital Care | In-Network: Acute Hospital Services: Out-of-Network: |
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: |
Emergency Room Visit | Copayment for Emergency Care $0.00 Worldwide Coverage: |
Ambulance Transportation | In-Network: Ground Ambulance: Air Ambulance: 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. Out-of-Network: Ambulance Services: |
Health Care Services and Medical Supplies
UHC Dual Complete MO-S002 (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: Out-of-Network: |
Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Out-of-Network: |
Durable Medical Eqipment (DME) | In-Network: Out-of-Network: |
Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Outpatient Diag/Therapeutic Rad Services: Out-of-Network: Outpatient Diag Procs/Tests/Lab Services: |
Home Health Care | In-Network: Out-of-Network: |
Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: Out-of-Network: |
Mental Health Outpatient Care | In-Network: Out-of-Network: |
Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Outpatient Observation Services: Ambulatory Surgical Center Services: Out-of-Network: Outpatient Hospital and ASC Services: |
Outpatient Substance Abuse Care | In-Network: Out-of-Network: |
Over-the-counter (OTC) Items | In-Network: Over-The-Counter (OTC) Items: Out-of-Network: Over-The-Counter (OTC) Items: |
Podiatry Services | In-Network:
Prior Authorization Required for Podiatry Services Out-of-Network: |
Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: Out-of-Network: |
Dental Benefits
The following dental services are covered from in-network providers.
Coverage | Cost |
---|---|
Dental Care | In-Network: Preventive Dental:
Copayment for Prophylaxis (Cleaning) $0.00
Copayment for Fluoride Treatment $0.00
Copayment for Dental X-Rays $0.00
Maximum Plan Benefit of $4000.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined Comprehensive Dental:
Copayment for Restorative Services $0.00
Copayment for Endodontics $0.00
Copayment for Periodontics $0.00
Copayment for Extractions $0.00
Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00
Maximum Plan Benefit of $4000.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined Out-of-Network: Medicare Covered Dental Services: |
Vision Benefits
The following vision services are covered from in-network providers.
Coverage | Cost |
---|---|
Vision Benefits | In-Network: Eye Exams:
Prior Authorization Required for Eye Exams Eyewear:
Maximum Plan Benefit of $300.00 every year for all Non-Medicare covered eyewear for in and out of network services combined Out-of-Network: Medicare Covered Vision Services: |
Hearing Benefits
The following hearing services are covered from in-network providers.
Coverage | Cost |
---|---|
Hearing Benefits | In-Network: Hearing Exams:
Prior Authorization Required for Hearing Exams Hearing Aids:
Maximum Plan Benefit of $2500.00 every year both ears combined for in and out of network services combined Out-of-Network: Medicare Covered Hearing Services: |
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: Abdominal aortic aneurysm screening
Tobacco use cessation Out-of-Network: Medicare-covered Zero Dollar Preventive Services: |
Prescription Drug Costs and Coverage
The UHC Dual Complete MO-S002 (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 |
|
Generic |
|
Preferred Brand |
|
Non-Preferred Drug |
|
Specialty Tier |
|
Annual Drug Deductible | $0 |
Preferred Generic |
|
Generic |
|
Preferred Brand |
|
Non-Preferred Drug |
|
Specialty Tier |
|
Annual Drug Deductible | $0 |
Preferred Generic |
|
Generic |
|
Preferred Brand |
|
Non-Preferred Drug |
|
Specialty Tier |
|
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