2027 UHC Dual Complete HI-YL (PPO D-SNP)
Medicare
What is a dual special needs plan?
H6824-003 -000
Monthly premium: $0.00 *
*Your costs may be as low as $0, depending on your level of Extra Help.
This Preferred Provider Organization (PPO) plan gives you more benefits than Original Medicare, all with as low as a $0 plan premium. You'll keep all your Medicaid benefits, and add even more. Must have full Medicaid benefits and LTSS. Joining this plan provides a combined Medicare and Medicaid experience: HI: FBDE, QMB PLUS, SLMB PLUS. Integrated SEP available. View your state-level D-SNP Enrollment At-a-Glance guide on Jarvis to learn more. Special eligibility requirement
- 2027 UHC Dual Complete HI-YL (PPO D-SNP)
1-844-812-5967 TTY: 711 8 a.m.-8 p.m. local time, 7 days a week
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Benefits & features
$247 credit every month for OTC, plus healthy food and utilities for qualifying members
$2,500 dental allowance for covered preventive and comprehensive services
$0 copay for covered brand-name and generic prescriptions
Dedicated care support to help access, plan and coordinate care and resources
24 one-way trips for pharmacies and grocery stores
Fitness benefit
Free gym membership at premium locations
Medical visits
$0 copay for hospital stays, PCP and specialist visits
No referrals and provider network
No referrals and large network of providers
Routine foot care
4 foot care visits for nail trims and other covered preventive care
Optum HouseCalls
Yearly in-home health and wellness visit with a licensed health care practitioner
Benefits, features and/or devices may vary by plan/area.
Limitations, exclusions and/or network restrictions may apply.
Optum HouseCalls may not be available in all areas.
Network size varies by local market and exclusions may apply.
Routine transportation not for use in emergencies.
A trip is one-way and roundtrip is two trips.
A 50% coinsurance may apply to covered comprehensive dental services.
If your plan offers out-of-network dental coverage and you see an out-of-network dentist, you might be billed more. Network size varies by local market.
The fitness benefits and gym networks vary by plan/area and participating locations may change. The fitness benefit includes a standard fitness membership at participating locations. Consult your doctor prior to beginning an exercise program or making changes to your lifestyle or health care routine.
OTC, food and utility benefits have expiration timeframes.
Review your Evidence of Coverage (EOC) for more information.
The healthy food and utilities benefit is a special supplemental benefit available only to chronically ill enrollees with a qualifying condition, such as diabetes, cardiovascular disorders, chronic heart failure, chronic high blood pressure and/or chronic high cholesterol, who also meet plan criteria indicating they are at high risk for hospitalization and eligible for intensive care coordination.
There may be other qualifying chronic conditions not listed. If you use this benefit for certain utilities, it may be considered income for housing assistance. Check with your housing authority for details.
UHC Dual Complete HI-YL (PPO D-SNP)
Monthly plan premium for people who get Extra Help from Medicare to help pay for their prescription drug costs
If you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine your total monthly plan premium as a member of our Plan.
This table shows you what your monthly plan premium will be if you get Extra Help.
| Your level of Extra Help | Monthly premium* |
|---|---|
| 100% | $0.00 |
*This does not include any Medicare Part B premium you may have to pay.
If you aren’t getting Extra Help, you can see if you qualify by calling:
- 1-800-Medicare or TTY users call 1-877-486-2048 (24 hours a day/7 days a week),
- Your State Medicaid Office, or
- The Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778 between 8 a.m. and 7 p.m., Monday through Friday.
Your health care needs are unique. These documents can help you make sure you get the right coverage.
Documents include Annual Notice of Changes, Evidence of Coverage, Formularies, Medicare Plan Star Ratings, Provider Directories, Summary of Benefits, Other downloadable resources.
Learn more about dual special needs plans
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UHC Dual Complete HI-YL (PPO D-SNP)