2021 UnitedHealthcare Dual Complete® Plan 1 (HMO D-SNP)

2020 UnitedHealthcare Dual Complete® Focus (HMO D-SNP) H4527-004-000

Dual Special Needs Plan (DSNP)

H4527-004-000

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.

Aransas, Kleberg, Nueces, and San Patricio.

Texas members who have questions about Coronavirus (COVID-19), can visit the Texas Health & Human Services at https://www.dshs.texas.gov/coronavirus/

Benefits & Features

Dental

$0 copay for covered preventive and diagnostic dental including commonly used oral exams, x-rays and routine cleanings

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

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

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

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

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

Hearing

Routine hearing exam and $2500 allowance toward name-brand hearing aids or UnitedHealthcare Hearing's exclusive brand Relate™

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 $420 yearly on a debit card to buy over-the-counter products at many retailers or for home delivery

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® Plan 1 (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% $5.50
50% $10.90
25% $16.40

*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