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

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

Dual Special Needs Program (DSNP)

H0169-003-000

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.

Adams, Antelope, Boone, Buffalo, Burt, Butler, Cass, Clay, Colfax, Cuming, Custer, Dakota, Dixon, Dodge, Douglas, Fillmore, Gage, Hall, Hamilton, Howard, Jefferson, Johnson, Kearney, Knox, Lancaster, Madison, Merrick, Nuckolls, Otoe, Pawnee, Pierce, Platte, Polk, Saline, Sarpy, Saunders, Seward, Sherman, Stanton, Thayer, Thurston, Washington, Webster, and York.

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

Health Products Card™

Up to $1,200 loaded onto your card annually.

Every 3 months you'll receive $300 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.

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.

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.
  • $300 credit toward glasses or contacts every year.

Don't let hearing loss affect your life. Take advantage of the routine hearing exam and hearing aids benefit.

Routine Hearing coverage includes:

  • One routine hearing exam every year.
  • $1100 credit toward hearing aids every 2 years.
  • Support and assistance to help you hear better.

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

24-hr. NurseLine

Speak with a registered nurse anytime for $0.

Additional Benefits

More benefits than Original Medicare.

Chiropractic Coverage

$0 copay for up to 10 visits per year for pain relief due to things that affect muscles, nerves and bones.

Fitness Benefit

A fitness program for body and mind with access to participating gym and fitness centers for $0.

Foot Care Coverage

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

Meal Program

Up to 14 meals in 7 days delivered once per year with $0 copay.

No Referral Needed

Your choice of specialists within the network.

Prescription Drug Coverage

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

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% $7.90
50% $15.70
25% $23.60

*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