2021 UnitedHealthcare Dual Complete® (HMO D-SNP)

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

Dual Special Needs Plan (DSNP)

H0169-003-000

Monthly Premium: $0.00*

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

This Health Maintenance Organization (HMO) plan gives you more benefits than Original Medicare, all for a $0 plan premium. You’ll keep all your Medicaid benefits, and add even more.

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

Dental

Up to $2500 for covered dental services such as certain cleanings, fillings, crowns, root canals, extractions and dentures

Renew Active™ is a fitness program for body and mind to help stay active, at a gym or from home, at no additional cost

Up to $1,200 yearly to buy over-the-counter products in-store or for home delivery, plus up to $360 yearly in healthy food at many retailers

$0 drug copays on all tiers of covered generic and name-brand prescription medications with option for home delivery

$0 copay virtual provider visits to discuss non-emergency medical concerns or general mental health conditions from home

Chiropractic

$0 copay for up to 12 routine chiropractic visits per year for relief of nausea or nerve, muscle, or joint pain

Food Allowance

Up to $360 yearly on a debit card to buy fruits, vegetables, dairy products, meats, breads and more at many retailers

Foot Care - Routine

Up to 4 foot care visits per year with $0 copay to help keep feet healthy with routine exams and preventive care

Hearing

Routine hearing exam and $1100 allowance toward name-brand hearing aids or UnitedHealthcare Hearing's exclusive brand Relate™

HouseCalls

Yearly check-ups at home to help stay up-to-date on your health between regular doctor's visits at no extra cost

Meal Benefit

$0 copay for up to 14 meals for 7 days, delivered 1 time per year after a hospital stay to maintain nutrition

Nursing Hotline

Speak to a registered nurse about your health-related questions or concerns anytime, day or night at no extra cost

OTC Items - Debit

Up to $1,200 yearly on a debit card to buy over-the-counter products at many retailers or for home delivery

Personal emergency response system

Personal emergency response device that can get you help quickly, 24 hours a day at no extra cost

Referral

Access to our large provider network with no specialty referrals required

Telehealth Medical

$0 copay virtual provider visits to discuss medical concerns, get a diagnosis and treatment for non-emergency conditions

Telehealth Mental

$0 copay virtual mental health visits to get a private evaluation and treatment for general mental health conditions

Vision

Routine eye exam and $300 allowance for contacts or frames, with standard (single, bi-focal, tri-focal or standard progressive) lenses covered in full

Worldwide ER

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% $9.50
50% $19.00
25% $28.50

*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