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UnitedHealthcare Community Plan
UnitedHealthcare Community Plan
You have selected UnitedHealthcare Dual Complete™ (HMO SNP).
The plan you are looking for is no longer available. This is the current year equivalent.

UnitedHealthcare Dual Complete™ (HMO SNP)

This plan gives you a choice doctors and hospitals. Plus you get coverage for a long list of prescription drugs.

Call us to learn more:
1-866-864-2079 / TTY: 711

Call us to learn more:
1-866-864-2079
TTY: 711

8 a.m. – 8 p.m. local time,
7 days a week

8 a.m. – 8 p.m. local time,
7 days a week

Have Questions? Call Us at:
1-866-864-2079 / TTY: 711

Have Questions? Call Us at:
1-866-864-2079
TTY: 711

8 a.m. – 8 p.m. local time,
7 days a week

8 a.m. – 8 p.m. local time,
7 days a week

See if your doctor or hospital is in our network. Or use this tool to find a new doctor, hospital or specialist.

This plan is available in the following counties:

Bee, Jim Wells, Kleberg, Nueces and San Patricio.

View Eligibility

Dental Work

$2,000 toward dental procedures.

We cover up to $2,000 every year for dental procedures you may need. There is no cost to you.

Our plan includes:

  • Restorative services like crowns.
  • Tooth extractions and more.

Health Products Catalog

Up to $520 in credits each year to buy things you need.

We’ll deliver them directly to you, with no cost for shipping, handling or taxes.

Our catalog offers products like:

  • Toothbrushes and bandages.
  • Cough medicine and vitamins.
  • Thermometers, blood pressure monitors and much more.

Transportation Assistance

Up to 24 one-way rides every year.

Whether you live in the city or in the country, our plan provides up to 12 round trips to and from plan-sponsored locations.

Emergency Care

Travel freely with worldwide emergency care.

You may go to any emergency room if you reasonably believe you need emergency care. And that’s true anywhere in the world. No matter where you go, you’ll have peace of mind with worldwide coverage.

Additional Eyewear

Credit for contacts or lenses and frames.

Get the eyewear you need to see clearly and look great. Coverage includes:

  • $70 credit toward contact lenses every 2 years.
  • $105 credit toward contacts every 2 years.

Dental Exams

$0 copay for routine exams.

Exams and cleanings help keep teeth and gums strong and healthy.

We cover the recommended routine dental exams. There is no additional cost to you.

Our plan includes:

  • Regular checkups and cleanings every 6 months.
  • Routine complete x-rays twice every year.

Provider Network

Choice of doctors and hospitals.

From regular checkups to preventive health screenings, we want to make sure you get the right care at the right time.

You get a primary care physician (PCP) who is your main doctor. If you don’t have a doctor or if your doctor is not in our network, we can help you find a new one close to you.

Your PCP is your main doctor for:

  • Preventive care.
  • Treatment if you are sick or injured.
  • Referrals to specialists for certain conditions.

Hearing Aids

$2,000 credit every 2 years.

If you’d benefit from a hearing aid, we’ll help you get one. At no additional cost.

NurseLineSM

Speak with a registered nurse anytime.

Everyone has questions about their health. With NurseLine, you can call 24 hours a day, 7 days a week. You’ll get answers about your health when you need them most. There is no cost to you.

Dental Work

$2,000 toward dental procedures.

We cover up to $2,000 every year for dental procedures you may need. There is no cost to you.

Our plan includes:

  • Restorative services like crowns.
  • Tooth extractions and more.

Health Products Catalog

Up to $520 in credits each year to buy things you need.

We’ll deliver them directly to you, with no cost for shipping, handling or taxes.

Our catalog offers products like:

  • Toothbrushes and bandages.
  • Cough medicine and vitamins.
  • Thermometers, blood pressure monitors and much more.

Transportation Assistance

Up to 24 one-way rides every year.

Whether you live in the city or in the country, our plan provides up to 12 round trips to and from plan-sponsored locations.

Emergency Care

Travel freely with worldwide emergency care.

You may go to any emergency room if you reasonably believe you need emergency care. And that’s true anywhere in the world. No matter where you go, you’ll have peace of mind with worldwide coverage.

Additional Eyewear

Credit for contacts or lenses and frames.

Get the eyewear you need to see clearly and look great. Coverage includes:

  • $70 credit toward contact lenses every 2 years.
  • $105 credit toward contacts every 2 years.

Dental Exams

$0 copay for routine exams.

Exams and cleanings help keep teeth and gums strong and healthy.

We cover the recommended routine dental exams. There is no additional cost to you.

Our plan includes:

  • Regular checkups and cleanings every 6 months.
  • Routine complete x-rays twice every year.

Provider Network

Choice of doctors and hospitals.

From regular checkups to preventive health screenings, we want to make sure you get the right care at the right time.

You get a primary care physician (PCP) who is your main doctor. If you don’t have a doctor or if your doctor is not in our network, we can help you find a new one close to you.

Your PCP is your main doctor for:

  • Preventive care.
  • Treatment if you are sick or injured.
  • Referrals to specialists for certain conditions.

Hearing Aids

$2,000 credit every 2 years.

If you’d benefit from a hearing aid, we’ll help you get one. At no additional cost.

NurseLineSM

Speak with a registered nurse anytime.

Everyone has questions about their health. With NurseLine, you can call 24 hours a day, 7 days a week. You’ll get answers about your health when you need them most. There is no cost to you.

Monthly Premium1*

$0.00

1Amount shown does not include Medicare Part B premium, which you must continue to pay if not otherwise paid for under Medicaid or by another third party. Beneficiaries who qualify for extra help may pay a lower monthly plan premium. For more information, see Paying for Medicare.

*Your costs may be as low as $0, depending on your level of Medicaid eligibility. Please call 1-866-864-2079 TTY: 711 8 a.m. – 8 p.m. local time, 7 days a week for more information on your costs with this plan.

Drug Copays or Coinsurance*

25% for Tier 1
25% for Tier 2
25% for Tier 3
25% for Tier 4
25% for Tier 5
*Your costs may be as low as $0, depending on your level of Medicaid eligibility. Please call 1-866-864-2079 TTY: 711 8 a.m. – 8 p.m. local time, 7 days a week for more information on your costs with this plan.

Medical Copays, Coinsurance or Deductible*

Office Visits2
$0.00 for primary care physicians
20% for specialists

Inpatient Hospital Visits3
$1188.00 per stay

 

2Numbers shown in this table reflect in-network copayments. Depending on the type of plan you choose, if you obtain care from out-of-network providers, those services may not be covered by the plan or you may have to pay higher copayments/coinsurance than shown here. See a plan's Evidence of Coverage for specific copayments or coinsurance.

3Amounts may vary depending on the level of care provided or the type of health care services you receive.

*Your costs may be as low as $0, depending on your level of Medicaid eligibility. Please call 1-866-864-2079 TTY: 711 8 a.m. – 8 p.m. local time, 7 days a week for more information on your costs with this plan.

Out-of-Pocket Maximum*

In-network
$6700
*Your costs may be as low as $0, depending on your level of Medicaid eligibility. Please call 1-866-864-2079 TTY: 711 8 a.m. – 8 p.m. local time, 7 days a week for more information on your costs with this plan.

Help With Costs

UnitedHealthcare Dual Complete™ (HMO SNP) premium includes coverage for both medical services and prescription drug coverage. 

If you receive help from Medicare to pay your prescription drug costs, you probably qualify for help reducing your monthly premium.

This help doesn't pay for everything – you must still pay your Medicare Part B premium (if it's not paid for by Medicaid or another group).

Who to Call

If you have any questions, please call Customer Service at 1-866-864-2079 / TTY: 711 from 8 a.m. – 8 p.m. local time, 7 days a week. 

If you don't get any extra help now, check to see if you qualify by calling:

  • Medicare at 1-800-Medicare (TTY/TDD users can call 1-877-486-2048) 24 hours a day, 7 days a week
  • Your State Medicaid Office
  • Social Security at 1-800-772-1213 (TTY/TDD users can call 1-800-325-0778) between 7:00 AM and 7:00 PM, Monday through Friday
Level Of Extra Help 100% 75% 50% 25%
Adjusted Premium $0.00 $4.80 $9.60 $14.50

State Pharmaceutical Assistance Program

State Pharmaceutical Assistance Programs (SPAP) help low-income residents pay for prescription drug costs. To learn how to contact your state SPAP, call 1-866-255-4835, 24 hours a day, 7 days a week. TTY users, call 1-877-730-4192. Or, visit the Web site of the State Pharmaceutical Assistance Program.

Best Available Evidence policy

Learn about the Best Available Evidence policy from CMS and how it pertains to you.

Pharmaceutical Assistance Programs for Texas

A State Pharmaceutical Assistance Program (SPAP) provides state-funded prescription drug assistance to people who need help paying for their monthly prescription drug plan premiums and/or copays.

For most programs, members must meet specific income guidelines and additional requirements that vary by state.

All Evercare prescription drug plans for Texas coordinate assistance with this program:

Kidney Health Care

You may be eligible for financial assistance through your state. To learn how to contact your state SPAP, call 1-866-255-4835, 24 hours a day, 7 days a week. TTY users, call 1-877-730-4192. Or, visit the Web site of the State Pharmaceutical Assistance Program.

Monthly Premium1*

$0.00

1Amount shown does not include Medicare Part B premium, which you must continue to pay if not otherwise paid for under Medicaid or by another third party. Beneficiaries who qualify for extra help may pay a lower monthly plan premium. For more information, see Paying for Medicare.

*Your costs may be as low as $0, depending on your level of Medicaid eligibility. Please call 1-866-864-2079 TTY: 711 8 a.m. – 8 p.m. local time, 7 days a week for more information on your costs with this plan.

Drug Copays or Coinsurance*

25% for Tier 1
25% for Tier 2
25% for Tier 3
25% for Tier 4
25% for Tier 5
*Your costs may be as low as $0, depending on your level of Medicaid eligibility. Please call 1-866-864-2079 TTY: 711 8 a.m. – 8 p.m. local time, 7 days a week for more information on your costs with this plan.

Medical Copays, Coinsurance or Deductible*

Office Visits2
$0.00 for primary care physicians
20% for specialists

Inpatient Hospital Visits3
$1188.00 per stay

 

2Numbers shown in this table reflect in-network copayments. Depending on the type of plan you choose, if you obtain care from out-of-network providers, those services may not be covered by the plan or you may have to pay higher copayments/coinsurance than shown here. See a plan's Evidence of Coverage for specific copayments or coinsurance.

3Amounts may vary depending on the level of care provided or the type of health care services you receive.

*Your costs may be as low as $0, depending on your level of Medicaid eligibility. Please call 1-866-864-2079 TTY: 711 8 a.m. – 8 p.m. local time, 7 days a week for more information on your costs with this plan.

Out-of-Pocket Maximum*

In-network
$6700
*Your costs may be as low as $0, depending on your level of Medicaid eligibility. Please call 1-866-864-2079 TTY: 711 8 a.m. – 8 p.m. local time, 7 days a week for more information on your costs with this plan.

Help With Costs

UnitedHealthcare Dual Complete™ (HMO SNP) premium includes coverage for both medical services and prescription drug coverage. 

If you receive help from Medicare to pay your prescription drug costs, you probably qualify for help reducing your monthly premium.

This help doesn't pay for everything – you must still pay your Medicare Part B premium (if it's not paid for by Medicaid or another group).

Who to Call

If you have any questions, please call Customer Service at 1-866-864-2079 / TTY: 711 from 8 a.m. – 8 p.m. local time, 7 days a week. 

If you don't get any extra help now, check to see if you qualify by calling:

  • Medicare at 1-800-Medicare (TTY/TDD users can call 1-877-486-2048) 24 hours a day, 7 days a week
  • Your State Medicaid Office
  • Social Security at 1-800-772-1213 (TTY/TDD users can call 1-800-325-0778) between 7:00 AM and 7:00 PM, Monday through Friday
Level Of Extra Help 100% 75% 50% 25%
Adjusted Premium $0.00 $4.80 $9.60 $14.50

State Pharmaceutical Assistance Program

State Pharmaceutical Assistance Programs (SPAP) help low-income residents pay for prescription drug costs. To learn how to contact your state SPAP, call 1-866-255-4835, 24 hours a day, 7 days a week. TTY users, call 1-877-730-4192. Or, visit the Web site of the State Pharmaceutical Assistance Program.

Best Available Evidence policy

Learn about the Best Available Evidence policy from CMS and how it pertains to you.

Pharmaceutical Assistance Programs for Texas

A State Pharmaceutical Assistance Program (SPAP) provides state-funded prescription drug assistance to people who need help paying for their monthly prescription drug plan premiums and/or copays.

For most programs, members must meet specific income guidelines and additional requirements that vary by state.

All Evercare prescription drug plans for Texas coordinate assistance with this program:

Kidney Health Care

You may be eligible for financial assistance through your state. To learn how to contact your state SPAP, call 1-866-255-4835, 24 hours a day, 7 days a week. TTY users, call 1-877-730-4192. Or, visit the Web site of the State Pharmaceutical Assistance Program.

Downloadable Resources

UnitedHealthcare Dual Complete™ (HMO SNP)

Medicare Plan Rating
Summary of Benefits
Evidence of Coverage
Health Products Benefit
Annual Notice of Changes

Questions?

Ready to Enroll?

Call Us
1-866-864-2079
TTY: 711

8 a.m. – 8 p.m. local time,
7 days a week

Enrollment Tools

Member Information

Summary of Benefits

More Resources

Member Page

View more news, updates and resources for members.

Lookup Tools

Doctor Lookup

Search for doctors, hospitals, and specialists.

Download the General Provider and Facilities Directory.

Dentist Lookup

Find a dentist near you.

Pharmacy Search

Find a pharmacy near you.

View Drug List

Find medications covered by this plan.

Enrollment Tools

Member Information

More Resources

View more news, updates and resources for members.

Disclaimer Information

UnitedHealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, co-payments, and restrictions may apply.

Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party. Premiums, copays, co-insurance and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

UnitedHealthcare Senior Care Options (HMO SNP) Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.  

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply.

Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party. Premiums, copays, co-insurance and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Enrollees have no out of pocket costs.

Availability of Non-English Disclaimer

This information is available for free in other languages. Please call our customer service number at 1-800-905-8671, TTY 711, 8 a.m. - 8 p.m. local time, 7 days a week.

Esta información está disponible sin costo en otros idiomas. Comuníquese con nuestro Servicio al Cliente al número 1-800-905-8671, TTY 711, de 8 a.m. – 8 p.m. hora local, los 7 días de la semana.

Star Ratings Disclaimer

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

Formularies on Plan Sponsor Websites

This drug may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.

UnitedHealthcare Dual Complete Plans cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and may be as effective as brand name drugs.

This is not a complete list of all formulary alternatives covered by the Part D plan for the drug you have selected.

Texas Disclaimer Information

Contact the Texas Health and Human Services Commission (http://www.hhsc.state.tx.us) to get more information about the Medicaid Services available to you.

Get a printed list of Texas Medicaid participating doctors, clinics, hospitals and other providers available for your health care by calling the Enrollment Helpline 1-800-964-2777. You can also search for Texas Medicaid participating providers on the Texas Medicaid & Healthcare Partnership's (TMHP) website (http://www.tmhp.com).

If you have a disabling medical condition, the state of Texas may be able to help you with a program called Long-Term Services and Supports. The goal of this program is to help you remain as independent as you can. You can learn about these services from your STAR+PLUS health plan or the Texas Department of Aging and Disability Services (DADS).

If you are enrolled in a STAR+PLUS Medicaid health plan, here is the information you need to contact them:


Health PlanPhone Numbers
Evercare 1-800-349-0550
Amerigroup 1-800-600-4441
(TTY/TDD 1-800-855-2880)
Molina 1-866-449-6849
(TTY/TDD 1-800-735-2989 (English)
or
1-800-662-4954 (Spanish)
Superior 1-866-615-9399 ext 22702

If you are not enrolled in a STAR+PLUS Medicaid health plan and need help, you can call DADS at 1-888-902-9990 or visit their website at http://www.dads.state.tx.us/services/index.cfm.