2019 UnitedHealthcare Dual Complete® (HMO SNP) H0169-003

2020 UnitedHealthcare Dual Complete® (HMO D-SNP) H0169-003-000

Dual Special Needs Program (DSNP)

H0169-003

Monthly Premium: $0.00*

 * Your costs may be as low as $0, depending on your level of Medicaid eligibility. H0169-003

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

Adams, Buffalo, Burt, Cass, Dodge, Douglas, Gage, Hall, Lancaster, Madison, Otoe, Saline, Sarpy, Saunders, Seward, and Washington.

Taking Action to Support People Affected by Flooding in Nebraska 

  • Help Finding a Network Care Provider, Early Refills: Plan participants who need help finding a care provider in the UnitedHealthcare network or obtaining early prescription refills can call Member Services at 1-844-445-7226, TTY 711  

  • Misplaced Medical ID cards, call 866-633-2446, 8 a.m.- 8 p.m. (in the local time zone), Monday through Friday. If you have a smartphone, download the free Health4Me app, which provides instant access to your ID card, network care providers, personal health benefits and more.  

  • Free Help Line: Optum, a leading health and behavioral health services company, is offering a free emotional-support help line. Call the toll-free number at 866-342-6892, available 24 hours a day, seven days a week. The service is free of charge and open to anyone.   

  • Searching for Community Resources: Call Member Services at 1-844-445-7226, TTY 711.

Benefits & Features

Dental Coverage

$1,500 toward dental services.

Protect your teeth and your gums by receiving regular dental care at no extra cost to you.

Dental coverage includes:

  • $1,500 toward your dental services.
  • Regular exams and cleanings every 6 months.
  • Restorative services like fillings, crowns, periodontal services, extractions, root canals and more.

Every 3 months you'll receive $140 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.

Help protect your eyesight and health with routine eye exams at no extra cost to you.

Vision coverage includes:

  • One routine eye exam every year.
  • $0 copay for standard eyeglass lenses.
  • $200 credit toward glasses or contacts every year.

Vision Provider Lookup

Keep your body balanced, flexible and functioning at its best.

Acupuncture and chiropractic coverage may include:

  • Combination of routine chiropractic and acupuncture visits.
  • Pain relief due to things that affect muscles, nerves and bones.
  • Treatment to relieve nausea symptoms.

Get connected to a trained operator quickly in any emergency situation 24 hours a day at no extra cost.

24-hr. NurseLine

Speak with a registered nurse anytime at no extra cost.

Additional Benefits

More benefits than Original Medicare.

Foot Care Coverage

$0 copay for up to 4 visits per year to help keep your feet healthy.

Hearing Coverage

Annual exam and $1,000 every 2 years for hearing devices.

House Calls

Get a home visit from a health care practitioner at no extra cost.

Meal Program

Up to 14 meals in 7 days delivered to you with $0 copay.

No Referral Needed

Your choice of specialists within the network.

Prescription Drugs

Thousands of drugs available.

UnitedHealthcare Dual Complete® (HMO 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% $7.10
50% $14.10
25% $21.20

*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.

Downloadable Resources

Member Resources

View Available Resources