D-SNP Plan Costs & Benefits

UnitedHealthcare Dual Complete 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.

Premiums, deductibles, and copays can widely vary between plans. It is important to compare costs and apply them to your personal financial and healthcare needs.

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
Primary (Out-of-Net)	40% coinsurance per visit
Primary (In-Network)	$0 copay
Specialist (In-Network)	$0 copay (authorization required)
Wellness programs (e.g., fitness, nursing hotline)	Covered
Preventive care	0-40% coinsurance
Mental Health Services
Outpatient group therapy visit (In-Network)	$0 copay (authorization required)
Inpatient hospital - psychiatric (Out-of-Net)	40% per stay (authorization required)
Inpatient hospital - psychiatric (In-Network)	$0 copay (authorization required)
Outpatient individual therapy visit with a psychiatrist (Out-of-Net)	40% coinsurance (authorization required)
Outpatient individual therapy visit (Out-of-Net)	40% coinsurance (authorization required)
Outpatient group therapy visit (Out-of-Net)	40% coinsurance (authorization required)
Outpatient individual therapy visit with a psychiatrist (In-Network)	$0 copay (authorization required)
Outpatient individual therapy visit (In-Network)	$0 copay (authorization required)
Outpatient group therapy visit with a psychiatrist (Out-of-Net)	40% coinsurance (authorization required)
Rehabilitation Services
Occupational therapy visit (In-Network)	$0 copay (authorization required)
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)
Medical Equipment / Supplies
Prosthetics (e.g., braces, artificial limbs) (In-Network)	$0 copay (authorization required)
Diabetes supplies (Out-of-Net)	40% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs) (Out-of-Net)	40% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen) (In-Network)	$0 copay (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen) (Out-of-Net)	40% coinsurance per item (authorization required)
Diagnostic Procedures / Lab Services / Imaging
Diagnostic radiology services (e.g., MRI) (In-Network)	$0 copay (authorization required)
Lab services (In-Network)	$0 copay (authorization required)
Outpatient x-rays (In-Network)	$0 copay (authorization required)
Diagnostic radiology services (e.g., MRI) (Out-of-Net)	40% coinsurance (authorization required)
Diagnostic tests and procedures (In-Network)	$0 copay (authorization required)
Outpatient x-rays (Out-of-Net)	40% coinsurance (authorization required)
Lab services (Out-of-Net)	$0 copay (authorization required)
Medicare Part B Drugs
Chemotherapy (In-Network)	$0 copay (authorization required)
Other Part B drugs (In-Network)	$0 copay (authorization required)
Other Part B drugs (Out-of-Net)	0-40% coinsurance (authorization required)
Foot Care (podiatry Services)
Routine foot care (In-Network)	$0 copay (authorization required, limits may apply)
Foot exams and treatment (In-Network)	$0 copay (authorization required)
Foot exams and treatment (Out-of-Net)	40% coinsurance (authorization required)
Hearing
Hearing aids (Out-of-Net)	$0 copay (authorization required, limits may apply)
Hearing exam (Out-of-Net)	40% coinsurance (authorization required)
Fitting/evaluation	Not covered
Hearing aids (In-Network)	$0 copay (authorization required, limits may apply)
Preventive Dental
Dental x-ray(s) (Out-of-Net)	$0 copay (limits may apply)
Oral exam (In-Network)	$0 copay (limits may apply)
Dental x-ray(s) (In-Network)	$0 copay (limits may apply)
Fluoride treatment (In-Network)	$0 copay (limits may apply)
Fluoride treatment (Out-of-Net)	$0 copay (limits may apply)
Cleaning (Out-of-Net)	$0 copay (limits may apply)
Cleaning (In-Network)	$0 copay (limits may apply)
Comprehensive Dental
Periodontics (Out-of-Net)	$0 copay (authorization required, limits may apply)
Restorative services (In-Network)	$0 copay (authorization required, limits may apply)
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network)	$0 copay (authorization required, limits may apply)
Diagnostic services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Extractions (In-Network)	$0 copay (authorization required, limits may apply)
Non-routine services (In-Network)	$0 copay (authorization required, limits may apply)
Periodontics (In-Network)	$0 copay (authorization required, limits may apply)
Prosthodontics, other oral/maxillofacial surgery, other services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Diagnostic services (In-Network)	$0 copay (authorization required, limits may apply)
Non-routine services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Restorative services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Endodontics (Out-of-Net)	$0 copay (authorization required, limits may apply)
Extractions (Out-of-Net)	$0 copay (authorization required, limits may apply)
Vision
Routine eye exam (Out-of-Net)	40% coinsurance (authorization required, limits may apply)
Other	Not covered
Contact lenses (Out-of-Net)	$0 copay (limits may apply)
Routine eye exam (In-Network)	$0 copay (authorization required, limits may apply)
Eyeglasses (frames and lenses) (In-Network)	$0 copay (limits may apply)
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses) (Out-of-Net)	$0 copay (limits may apply)
Eyeglass frames	Not covered
Upgrades	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 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 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 Rating Marks

Each year the Centers for Medicare & Medicaid Services rates Medicare Advantage D-SNP's using nine broad categories. Medicare Wizard does not recommend enrolling in an SNP plan with an overall rating of less than 3.0. (3 out of 5 stars)

Do You Qualify to Join UnitedHealthcare Dual Complete?

Unfortunately, not everyone on Medicare will qualify to join UnitedHealthcare Dual Complete. To join a 2023 Medicare Special Needs Plan in Sagadahoc County, Maine 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.

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

Medicare beneficiaries who don't qualify to enroll in UnitedHealthcare Dual Complete, or another Special Needs Plan, are encouraged to look at Sagadahoc County Medicare Advantage plans options.

Contact UnitedHealthcare

The 2023 Medicare Special Needs Plans for Sagadahoc County, Maine information on this page originates from Medicare.gov, is maintained by the All Medicare team, and was last updated on February 5, 2023.