2020 UnitedHealthcare Dual Complete® (HMO D-SNP) H0169-002-000

2019 UnitedHealthcare Dual Complete® (HMO SNP) H0169-002

Dual Special Needs Program (DSNP)

H0169-002-000

Monthly Premium: $0.00*

* Your costs may be as low as $0, depending on your level of Medicaid eligibility.

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

Adair, Andrew, Atchison, Audrain, Barry, Barton, Bates, Benton, Bollinger, Boone, Buchanan, Butler, Caldwell, Callaway, Camden, Carroll, Carter, Cass, Cedar, Chariton, Christian, Clark, Clay, Clinton, Cole, Cooper, Crawford, Dade, Dallas, Daviess, DeKalb, Dent, Douglas, Franklin, Gasconade, Gentry, Greene, Grundy, Harrison, Henry, Hickory, Holt, Howard, Howell, Iron, Jackson, Jasper, Jefferson, Johnson, Knox, Laclede, Lafayette, Lawrence, Lincoln, Linn, Livingston, Macon, Madison, Maries, McDonald, Mercer, Miller, Mississippi, Moniteau, Monroe, Montgomery, Morgan, New Madrid, Newton, Nodaway, Oregon, Osage, Ozark, Pemiscot, Perry, Pettis, Phelps, Pike, Platte, Polk, Pulaski, Putnam, Ralls, Randolph, Ray, Reynolds, Ripley, Sainte Genevieve, Saline, Scott, Shannon, Shelby, St. Charles, St. Clair, St. Francois, St. Louis, St. Louis City, Stoddard, Stone, Sullivan, Taney, Texas, Vernon, Warren, Washington, Wayne, Webster, Worth, and Wright.

Benefits & Features

Dental Coverage

$3500 toward dental services.

Protect your teeth and gums by receiving regular dental care.

Dental coverage includes:

  • Routine cleanings and periodontal maintenance.
  • Routine exams, commonly used x-rays and fluoride treatments.
  • Comprehensive services including certain types of: fillings, crowns, bridges, periodontal services, extractions, root canals, dentures, sedation and occlusal guards.

Every 3 months you'll receive $400 loaded onto your card. You can use the card to buy health products at your local Walgreens or through the FirstLine Medical® catalog by mail, website or call center.

Covered products may include:

  • Oral care, eye and ear care items.
  • Pain relievers, cold remedies and vitamins.
  • Thermometers, blood pressure monitors and more.

Renew Active™ is a fitness program for body and mind exclusively for UnitedHealthcare members for $0.

Fitness benefit may include:

  • Membership access to an extensive group of participating gym and fitness locations, including local and national options.
  • A personalized fitness plan with access to a wide variety of fitness classes. 
  • Online brain exercises designed to help keep your mind active.

We can help you get to plan-approved locations so you can take care of your health needs. 60 one-way or 30 round trips are available at no extra cost to you.

Transportation coverage may include:

  • Rides to health providers like doctors and dentists.
  • Rides to your pharmacy.
  • Wheelchair accessible vehicles as needed.

Annual routine exam and $400 credit every year for routine eyewear.

24-hr. NurseLine

Speak with a registered nurse anytime for $0.

Acupuncture and Chiropractic Coverage

$0 copay for up to 20 visits per year for pain relief due to things that affect muscles, nerves and bones.

Additional Benefits

More benefits than Original Medicare.

Fitness Activity Tracker

One Fitbit® activity tracker every two years at no extra cost.

Foot Care Coverage

$0 copay for up to 6 visits per year to help keep your feet healthy.

Meal Program

Up to 42 meals in 21 days delivered two times per year with $0 copay.

No Referral Needed

Your choice of specialists within the network.

Personal Emergency Response System

Get connected to a trained operator quickly in an emergency situation 24 hours a day for $0.

Prescription Drug Coverage

Access to thousands of prescription medications commonly chosen by doctors and pharmacies.

Routine Hearing Coverage

Annual routine exam and $2000 credit every 2 years for hearing aids.

Solutions for Caregivers

Speak to an experienced care manager who can provide resources to help meet your caregiving needs for $0.

UnitedHealthcare® HouseCalls

Get a yearly in-home preventative care visit with a health care practitioner at no extra cost.

Virtual Medical Visits

Talk to a provider 24 hours a day, 7 days a week with $0 copay.

Virtual Mental Health Visits

Get confidential care from a provider online and help keep your mental health in check with $0 copay.

Worldwide Emergency Coverage

Coverage for emergency and urgent care needs worldwide with $0 copay.

UnitedHealthcare Dual Complete® (HMO 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
75% $4.60
50% $9.30
25% $13.90

*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 of 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 7 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.

Downloadable Resources

Member Resources

View Available Resources