UHC Complete Care GS-001A (C-SNP): Costs+Coverage R2604-002-0
UHC Complete Care GS-001A (C-SNP): Costs+Coverage R2604-002-0
Discover how UHC Complete Care GS-001A (C-SNP PPO) stands out as a 2025 Special Needs Plan (SNP), offering tailored coverage to fit your individual needs. This page provides a comprehensive look at the plan’s benefits and costs, helping you make an informed choice.
Delivery of healthcare services and costs by UnitedHealthcare are different than Original Medicare. This private health insurance option may include additional benefits that are not provided by Medicare Part A and Part B.
Plan ID R2604-002-0 Overview | |
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Health Plan ID: | R2604-002-0 |
Medicare Advantage Plan Type: | PPO |
Plan Year: | 2024 |
Monthly Premium: | $20.70 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Basic $545.00 deductible |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | UnitedHealthcare |
We're Here to Help You Enroll |
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Health Plan Cost Sharing & Benefits
UHC Complete Care GS-001A is a Preferred Provider Organization (PPO) plan. As a member of this C-SNP plan, you typically access care through in-network providers, but you have the flexibility to see out-of-network providers if needed. Keep in mind that visits to non-network providers may result in higher out-of-pocket costs.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | 20% Coinsurance |
Specialist: | 20% Coinsurance Prior Authorization Required |
Wellness & Preventive Programs: | |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $0 Copay Prior Authorization Required |
Routine Foot Care: | $0 Copay Prior Authorization Required |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | 20% Coinsurance Prior Authorization Required |
Routine chiropractic: | $0 |
Emergency and Urgent Care | |
Emergency room care: | $80 Copay |
Urgent care: | $40 Copay |
Ground ambulance: | 20% Coinsurance |
Inpatient hospital care: | $1,750.00 per stay |
Outpatient hospital care: | 20% Coinsurance Prior Authorization Required |
Skilled Nursing Facility: | |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | 20% Coinsurance |
Outpatient group therapy: | 20% Coinsurance |
Inpatient psychiatric hospital care: | $1,750.00 per stay |
Outpatient group therapy: | 20% Coinsurance |
Outpatient individual therapy: | 20% Coinsurance Prior Authorization Required |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | 20% Coinsurance Prior Authorization Required |
Occupational therapy: | 20% Coinsurance Prior Authorization Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | $0 Copay Prior Authorization Required |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | 20% Coinsurance Prior Authorization Required |
Lab services: | $0 Copay Prior Authorization Required |
Outpatient x-rays: | 20% Coinsurance Prior Authorization Required |
Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Supplemental Health Plan Benefits (R2604-002-0)
The following is a summary of the supplemental benefits UnitedHealthcare includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Not Covered |
Vision | Maximum vision benefit: | $150.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay Prior Authorization Required |
Contact lenses (In-Network) | $0 Copay |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
UHC Complete Care GS-001A includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $20.70 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $20.70 |
Part D Premium with Full LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $545.00. This is the amount you must pay at the pharmacy before UnitedHealthcare begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, UHC Complete Care GS-001A has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
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$0 copay on all covered generic and brand-name prescriptions. |
CMS 5-Star Rating Marks
p>Each year, Medicare Advantage C-SNPs are rated by the Centers for Medicare & Medicaid Services (CMS) across nine categories using a 5-star system. These star ratings are designed to help you assess the quality of care and service offered by this UnitedHealthcare plan.CMS Measure | Star Rating |
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2025 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Eligibility Criteria for Enrolling in UHC Complete Care GS-001A
To enroll in UHC Complete Care GS-001A, you must meet the following criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You have been diagnosed with one or more severe or disabling chronic conditions.
A disabling chronic condition (disease) is one that persists for one year or longer, requiring ongoing medical care and/or limiting daily activities. These conditions include:
- Autoimmune disorders
- End-stage renal disease
- Cancer
- Cardiovascular disorders
- Blood disorders (Hematologic disorders)
- HIV/AIDS
- Chronic heart failure
- Chronic lung disorders
- Neurologic disorders
- Dementia
- Diabetes
- End-stage liver disease
- Stroke
- Mental health conditions
This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes.
Medicare Special Needs Plan Enrollment Periods
After determining your eligibility for UHC Complete Care GS-001A, it’s important to be aware of the Medicare Enrollment Periods, which determine when you can enroll in or change your plan. Depending on your circumstances, one of the following periods will apply:
- Initial Enrollment Period (IEP): Your first opportunity to enroll when you become eligible for Medicare.
- Annual Enrollment Period (AEP): The time each year when you can change your Medicare plan or enroll in a new one.
- Special Enrollment Periods (SEPs): Times outside of AEP when you can make changes due to specific circumstances, such as moving to a new area or losing other insurance coverage.
For comprehensive information on these enrollment periods, learn more here and make well-informed Medicare decisions.
Plan Availability
UHC Complete Care GS-001A (R2604-002-0) is available in the following locations (click to open):
Contact UnitedHealthcare
Call 1-877-388-0596 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Sun 8am-11pm EST) and learn more about this Special Needs Plan and other plans on this site.
You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
Plan Website: | http://UHC.com/Medicare |
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Formulay Information: | http://UHC.com/Medicare |
Pharmacy Information: | UnitedHealthcare Pharmacy Page |
Prospective Members: | (800)555-5757 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered through Medicare.org
Medicare Advantage and Part D plans and benefits offered are by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.