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UHC Dual Advantage NM-V1 (PPO D-SNP)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
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Monthly Premium
UHC Dual Advantage NM-V1 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealthcare
Plan ID: H0294-051
HelpAdvisor Editorial Team analysis of data from the 2027 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as UHC Dual Advantage NM-V1 (PPO D-SNP) - H0294-051 by UnitedHealthcare as well as other Medicare Advantage plans available in your area.
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Monthly Premium
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Drug Deductible | $480 |
| Out of Pocket Max | In-Network: $4900 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2100 |
| Primary Care Doctor Visit | Out-of-Network: Doctor Office Visit Services: Copayment for Medicare Covered Primary Care Office Visit $0 or $35 |
| Specialty Doctor Visit | In-Network: Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $0 to $35 Prior Authorization Required for Doctor Specialty Visit Note: The lower cost share applies to Medicare covered telehealth and Medicare covered remote monitoring. The higher cost share applies to all other Medicare covered services. |
| Inpatient Hospital Care | Out-of-Network: Acute Hospital Services: $505 per day for days 1 to 5 $0 per day for days 6 to 999 Note: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b. |
| Urgent Care | Urgent Care: Copayment for Urgent Care $0 to $50 Note: The lower cost share applies to Medicare covered telehealth. The higher cost share applies to all other Medicare covered services. |
| Emergency Room Visit | Emergency Care: Copayment for Emergency Care $0 or $130 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours |
| Ambulance Transportation | In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $0 or $350 Air Ambulance: Copayment for Air Ambulance Services $0 or $350 Prior Authorization Required for Air Ambulance |
Health Care Services and Medical Supplies
UHC Dual Advantage NM-V1 (PPO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | Out-of-Network: Chiropractic Services: Copayment for Medicare Covered Chiropractic Services $0 or $15 In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $0 or $15 Prior Authorization Required for Chiropractic Services |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Diabetic Supplies and Services: Copayment for Medicare-covered Diabetic Supplies $0 Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 0% or 20% |
| Durable Medical Equipment (DME) | Out-of-Network: Durable Medical Equipment Services: Coinsurance for Medicare Covered Durable Medical Equipment 0% or 20% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0 or $50 Copayment for Medicare-covered Lab Services $0 Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0 to $320 Coinsurance for Medicare-covered Therapeutic Radiological Services 0% or 20% Copayment for Medicare-covered X-Ray Services $0 or $30 |
| Home Health Care | Out-of-Network: Home Health Services: Copayment for Medicare Covered Home Health $0 |
| Mental Health Inpatient Care | Out-of-Network: Psychiatric Hospital Services: $505 per day for days 1 to 4 $0 per day for days 5 to 90 Benefit Details - General Note - NOTE ON INPATIENT SUBSTANCE ABUSE: All inpatient substance abuse and mental health care (including both care received in an acute care facility and a Medicare-certified psychiatric facility) are included in category 1b. |
| Mental Health Outpatient Care | In-Network: Outpatient Mental Health Services: Copayment for Medicare-covered Individual Sessions $0 to $25 Copayment for Medicare-covered Group Sessions $0 or $15 |
| Outpatient Services / Surgery | Out-of-Network: Outpatient Hospital Services: Coinsurance for Medicare Covered Outpatient Hospital Services 0% or 40% Coinsurance for Medicare Covered Ambulatory Surgical Center Services 0% or 40% Note: The lower cost share applies to outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures.Note: Benefit category includes both the facility and professional component. |
| Outpatient Substance Abuse Care | Out-of-Network: Outpatient Substance Abuse Services: Copayment for Medicare Covered Individual Sessions $0 or $40 Copayment for Medicare Covered Group Sessions $0 or $30 Note: The lower cost share applies to Medicare covered telehealth for individual sessions. The higher cost share applies to all other Medicare covered services. In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $0 to $25 Copayment for Medicare-covered Group Sessions $0 or $15 Prior Authorization Required for Outpatient Substance Abuse Services Note: The lower cost share applies to Medicare covered telehealth for individual sessions. The higher cost share applies to all other Medicare covered services. |
| Over-the-counter (OTC) Items | Out-of-Network: Over-The-Counter (OTC) Items Services: Coinsurance for Non-Medicare Covered Over-The-Counter (OTC) Items 0% or 90% |
| Podiatry Services | Out-of-Network: Podiatry Services: Copayment for Medicare Covered Podiatry Services $0 or $75 In-Network $35 copay 6 visits per year |
| Skilled Nursing Facility Care | Out-of-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $221 per day for days 21 to 100 |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | $0 copay for covered preventive services such as oral exams, routine cleanings, X-rays and fluoride You will have access to one of Medicare Advantage's largest dental networks, or you can choose any dentist. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | Out-of-Network: Eye Exams Services: Copayment for Medicare Covered Eye Exams $0 or $75 Copayment for Medicare Covered Eyewear $0 or $75 |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits |
In-Network Routine Hearing Exam: $0 copay 1 exam per year Routine Hearing Aids: $700 allowance up to 2 hearing aids per year Choose from a broad selection of brand-name prescription hearing aids through UnitedHealthcare Hearing. Access to one of the largest national networks with thousands of hearing professionals. Out-of-Network Routine Hearing Exam:$75 copay Routine Hearing Aids:90% coinsurance up to allowance |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | Out-of-Network: Medicare-covered Preventive Services: Coinsurance for Medicare Covered Medicare-covered Preventive Services 0% to 40% |
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