D-SNP Plan Costs & Benefits

UnitedHealthcare Dual Complete RP is a Preferred Provider Organization (PPO) plan. PPO plan members usually use in-network healthcare providers but can go out of network when necessary. However, visits to non-network providers could cost significantly more.

Costs vary widely from plan to plan. It is beneficial to compare costs, including premiums, deductibles, and copays, and apply them to your personal situation.

Healthcare Service	Member Cost
Health plan deductible	$0
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$12,450 In and Out-of-network $8,300 In-network
Doctor Visits
Specialist (In-Network)	$0 copay (authorization required)
Primary (Out-of-Net)	40% coinsurance per visit
Primary (In-Network)	$0 copay
Wellness programs (e.g., fitness, nursing hotline)	Covered
Preventive care	$0 copay
Mental Health Services
Outpatient group therapy visit with a psychiatrist (In-Network)	$0 copay (authorization required)
Outpatient group therapy visit (Out-of-Net)	40% coinsurance (authorization required)
Outpatient individual therapy visit (In-Network)	$0 copay (authorization required)
Outpatient group therapy visit (In-Network)	$0 copay (authorization required)
Inpatient hospital - psychiatric (Out-of-Net)	40% per stay (authorization required)
Outpatient individual therapy visit (Out-of-Net)	40% coinsurance (authorization required)
Outpatient individual therapy visit with a psychiatrist (In-Network)	$0 copay (authorization required)
Outpatient group therapy visit with a psychiatrist (Out-of-Net)	40% coinsurance (authorization required)
Inpatient hospital - psychiatric (In-Network)	$0 copay (authorization required)
Rehabilitation Services
Physical therapy and speech and language therapy visit (In-Network)	$0 copay (authorization required)
Physical therapy and speech and language therapy visit (Out-of-Net)	40% coinsurance (authorization required)
Occupational therapy visit (In-Network)	$0 copay (authorization required)
Medical Equipment / Supplies
Prosthetics (e.g., braces, artificial limbs) (In-Network)	$0 copay (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen) (In-Network)	$0 copay (authorization required)
Diabetes supplies (Out-of-Net)	20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs) (Out-of-Net)	20% coinsurance per item (authorization required)
Diabetes supplies (In-Network)	$0 copay (authorization required)
Diagnostic Procedures / Lab Services / Imaging
Diagnostic tests and procedures (Out-of-Net)	40% coinsurance (authorization required)
Lab services (In-Network)	$0 copay (authorization required)
Diagnostic tests and procedures (In-Network)	$0 copay (authorization required)
Outpatient x-rays (In-Network)	$0 copay (authorization required)
Outpatient x-rays (Out-of-Net)	40% coinsurance (authorization required)
Diagnostic radiology services (e.g., MRI) (Out-of-Net)	40% coinsurance (authorization required)
Diagnostic radiology services (e.g., MRI) (In-Network)	$0 copay (authorization required)
Medicare Part B Drugs
Other Part B drugs (In-Network)	$0 copay (authorization required)
Chemotherapy (In-Network)	$0 copay (authorization required)
Chemotherapy (Out-of-Net)	20% coinsurance (authorization required)
Foot Care (podiatry Services)
Routine foot care (Out-of-Net)	40% coinsurance (authorization required, limits may apply)
Foot exams and treatment (Out-of-Net)	40% coinsurance (authorization required)
Routine foot care (In-Network)	$0 copay (authorization required, limits may apply)
Hearing
Hearing exam (Out-of-Net)	40% coinsurance (authorization required)
Hearing exam (In-Network)	$0 copay (authorization required)
Hearing aids - outer ear	Not covered
Fitting/evaluation	Not covered
Hearing aids - inner ear	Not covered
Preventive Dental
Oral exam (In-Network)	$0 copay (limits may apply)
Dental x-ray(s) (Out-of-Net)	$0 copay (limits may apply)
Fluoride treatment (Out-of-Net)	$0 copay (limits may apply)
Dental x-ray(s) (In-Network)	$0 copay (limits may apply)
Cleaning (Out-of-Net)	$0 copay (limits may apply)
Cleaning (In-Network)	$0 copay (limits may apply)
Oral exam (Out-of-Net)	$0 copay (limits may apply)
Comprehensive Dental
Endodontics (In-Network)	$0 copay (authorization required, limits may apply)
Endodontics (Out-of-Net)	$0 copay (authorization required, limits may apply)
Extractions (In-Network)	$0 copay (authorization required, limits may apply)
Restorative services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Periodontics (In-Network)	$0 copay (authorization required, limits may apply)
Diagnostic services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Prosthodontics, other oral/maxillofacial surgery, other services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Restorative services (In-Network)	$0 copay (authorization required, limits may apply)
Periodontics (Out-of-Net)	$0 copay (authorization required, limits may apply)
Non-routine services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Non-routine services (In-Network)	$0 copay (authorization required, limits may apply)
Extractions (Out-of-Net)	$0 copay (authorization required, limits may apply)
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network)	$0 copay (authorization required, limits may apply)
Vision
Other	Not covered
Eyeglass frames	Not covered
Routine eye exam	Not covered
Upgrades	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	Not covered
Emergency Care / Urgent Care
Urgent care	$0 copay
Ground ambulance	$0 copay
Inpatient hospital coverage	40% per stay
Outpatient hospital coverage	$0 copay
Skilled Nursing Facility	$0 copay
Optional supplemental benefits	No

Prescription Costs & Benefits

A basic benefit Part D plan is bundled with this health plan. This simply means that UnitedHealthcare Dual Complete RP covers the minimum amount required by Medicare, whereas enhanced benefit plans cover more of the overall costs and may include more benefits.

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.

Prescription Drug Plan Deductible

The Medicare Part D annual deductible with this plan is $505.00. 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, UnitedHealthcare Dual Complete RP has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.

CMS 5-Star Rating

Each year Medicare rates D-SNP plans, like UnitedHealthcare Dual Complete RP, in nine categories. Medicare's plan ratings help consumers understand the quality of care and service they can expect if they qualify and choose to enroll.

Do You Qualify to Join UnitedHealthcare Dual Complete RP?

Unfortunately, not everyone on Medicare will qualify to join UnitedHealthcare Dual Complete RP. To join a 2023 Medicare Special Needs Plan in Kalawao County, Hawaii you must be eligible for both Medicare and Medicaid. To qualify for Medicare, you must be age 65 or older. People with SSDI benefits for a disability qualify after 24 months.

Hawaii Medicaid eligibility is based on your income and assets. Here are Hawaii's Medicaid thresholds.

If you don't qualify for UnitedHealthcare Dual Complete RP, or another Medicare Special Needs Plan in your area, Medicare Advantage plans available in Kalawao County, Hawaii may be another option.

Contact UnitedHealthcare

The Medicare SNP Plans for Kalawao County, Hawaii information on this page originates from Medicare.gov and was last updated by All Medicare on February 2, 2023.