UHC Dual Complete ME-S003 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H0271-065
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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 ME-S003 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H0271-065
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
UHC Dual Complete ME-S003 (PPO D-SNP) H0271-065 Plan Details
4 out of 5 stars
UHC Dual Complete ME-S003 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H0271-065
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
$0.00
Monthly Premium
Maine Counties Served
York Oxford Sagadahoc Knox Waldo Cumberland Androscoggin Franklin Kennebec Lincoln
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 ME-S003 (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
Comprehensive Dental: 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 $1100.00 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 ME-S003 (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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