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2021 UnitedHealthcare Dual Complete® LP (HMO D-SNP)

2022 UnitedHealthcare Dual Complete® LP (HMO D-SNP) H5253-059-000

Medicare

What is a dual special needs plan?

H5253-059-000

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 with as low as a $0 plan premium. You’ll keep all your Medicaid benefits, and add even more.

This plan is available in the following counties:

Butler, Clark, Cuyahoga, Franklin, Greene, Hamilton, Madison, Mahoning, Montgomery, Stark, Summit, Trumbull, and Warren.

Coronavirus (COVID-19) Update

Ohio members who have questions about coronavirus or who want to access the most current information about the outbreak, please visit https://coronavirus.ohio.gov.

Find providers and coverage for this plan.

Find a Provider

Search for doctors, hospitals, and specialists.

Find a Dentist

Find a dentist near you.

Find a Pharmacy

Find a pharmacy near you.

View Drug List

Find medications covered by this plan.

Benefits & Features

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Dental

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

Prescription Drug Coverage

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

OTC Items - Debit and Food Allowance

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

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

Transportation

$0 copay for 60 one-way rides to or from non-emergency medical doctor visits or to get prescription medications

See More Benefits and Features

Chiropractic

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

Fitness program

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

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

Hearing

Routine hearing exam and $3600 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 Medical & Mental

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

Telehealth Mental

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

Worldwide ER

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

Extra Help With Costs: LIS Premium Summary Table

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%	$7.40
50%	$14.90
25%	$22.30

*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