UHC Dual Complete WV-V001 (PPO D-SNP)

4 out of 5 stars
$0.00
Monthly Premium

UHC Dual Complete WV-V001 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealthcare

Plan ID: H0271-058

HelpAdvisor Editorial Team analysis of data from the 2025 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 Complete WV-V001 (PPO D-SNP) - H0271-058 by UnitedHealthcare as well as other Medicare Advantage plans available in your area.

$0.00
Monthly Premium

West Virginia Counties Served

BarbourBeaverBerkeleyBooneBraxtonBrookeCabellCalhounClayDoddridgeFayetteFrederickGilmerGrantGreenbrierHampshireHancockHardyHarrisonJacksonJeffersonKanawhaLewisLincolnLoganMarionMarshallMasonMcdowellMercerMineralMingoMonongaliaMonroeMorganNicholasOhioPendletonPleasantsPocahontasPrestonPutnamRaleighRandolphRitchieRoaneSummersTaylorTuckerTylerUpshurWayneWebsterWetzelWirtWoodWyoming

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $4900
Out-of-Network: N/A
Initial Coverage Limit $0
Catastrophic Coverage Limit $8000
Primary Care Doctor Visit

Out-of-Network:

Doctor Office Visit:
Copayment for Medicare Covered Primary Care Office Visit $20.00
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $0.00
Prior Authorization Required for Doctor Specialty Visit
Inpatient Hospital Care

Out-of-Network:
$0.00 per day for days 1 to 6
$0.00 per day for days 7 to 999
Urgent Care

Urgent Care:
Copayment for Urgent Care $0.00

Benefit Details - General 4b Note - NOTE ON COST SHARING RANGE FOR URGENTLY NEEDED SERVICES: $0 copayment applies to Medicare covered telehealth. The higher cost share applies to all other Medicare covered services.

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $0.00
Emergency Room Visit

Emergency Care:
Copayment for Emergency Care $0.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $0.00
Copayment for Worldwide Emergency Transportation $0.00
Ambulance Transportation

Out-of-Network:

Ambulance Services:
Copayment for Medicare Covered Ambulance Services - Ground $290.00
Copayment for Medicare Covered Ambulance Services - Air $290.00

Health Care Services and Medical Supplies

UHC Dual Complete WV-V001 (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
In-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $0.00
Prior Authorization Required for Chiropractic Services

Out-of-Network:

Chiropractic Services:
Copayment for Medicare Covered Chiropractic Services $20.00
Diabetes Supplies, Training, Nutrition Therapy and Monitoring

Out-of-Network:

Diabetic Supplies and Services:
Coinsurance for Medicare Covered Diabetic Supplies and Services 50%
Durable Medical Equipment (DME)
In-Network:

Durable Medical Equipment:
Copayment for Medicare-covered Durable Medical Equipment $0.00
Prior Authorization Required for Durable Medical Equipment
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0.00
Copayment for Medicare-covered Lab Services $0.00
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $0.00
Copayment for Medicare-covered Therapeutic Radiological Services $0.00
Copayment for Medicare-covered X-Ray Services $0.00
Prior Authorization Required for Outpatient Diag/Therapeutic Rad Services
Home Health Care

Out-of-Network:

Home Health Services:
Coinsurance for Medicare Covered Home Health 50%
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$0.00 per day for days 1 to 6
$0.00 per day for days 7 to 90
Prior Authorization Required for Psychiatric Hospital Services
Mental Health Outpatient Care

Out-of-Network:

Outpatient Mental Health Services:
Copayment for Medicare Covered Individual Sessions $30.00 to $40.00
Copayment for Medicare Covered Group Sessions $30.00 to $40.00
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0.00
Prior Authorization Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per day $0.00
Prior Authorization Required for Outpatient Observation Services

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0.00
Prior Authorization Required for Ambulatory Surgical Center Services
Outpatient Substance Abuse Care

Out-of-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual or Group Sessions $30.00 to $40.00
In-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $0.00
Copayment for Medicare-covered Group Sessions $0.00
Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter (OTC) Items

Out-of-Network:

Over-The-Counter (OTC) Items:
Copayment for Non-Medicare Covered Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $65.00
Podiatry Services
In-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $0.00
Copayment for Routine Foot Care $20.00
  • Maximum 6 visits every year
Prior Authorization Required for Podiatry Services

Out-of-Network:

Podiatry Services:
Copayment for Medicare Covered Podiatry Services $20.00
Podiatry Services:
Copayment for Non-Medicare Covered Podiatry Services $20.00
Skilled Nursing Facility Care

Out-of-Network:
$0.00 per day for days 1 to 43
$0.00 per day for days 44 to 100

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care

Out-of-Network:

Medicare Covered Dental Services:
Coinsurance for Medicare Covered Comprehensive Dental 40%
Non-Medicare Covered Dental Services:
Copayment for Non-Medicare Covered Preventive Dental $0.00
Coinsurance for Non-Medicare Covered Comprehensive Dental 0% to 50%

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits

Out-of-Network:

Medicare Covered Vision Services:
Copayment for Medicare Covered Eye Exams $20.00
Copayment for Medicare Covered Eyewear $20.00
Non-Medicare Covered Vision Services:
Copayment for Non-Medicare Covered Eye Exams $20.00
Copayment for Non-Medicare Covered Eyewear $0.00

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $0.00
Copayment for Routine Hearing Exams $0.00
  • Maximum 1 visit every year
Prior Authorization Required for Hearing Exams

Hearing Aids:
Maximum Plan Allowance of $1100.00 every year both ears combined for in and out of network services combined
Prior Authorization Required for Hearing Aids

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 Zero Dollar Preventive Services:
Coinsurance for Medicare Covered Medicare-covered Preventive Services 0% to 40%

Prescription Drug Costs and Coverage

The UHC Dual Complete WV-V001 (PPO D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $0 (excludes Tiers 1, 2 and 3) per year.

Coverage Cost
Coverage & Cost
Annual Drug Deductible $0 (excludes Tiers 1, 2 and 3)
Preferred Generic
  • Preferred cost-share mail order N/A
  • Standard retail $0.00
  • Standard mail order N/A
Generic
  • Preferred cost-share mail order N/A
  • Standard retail $0.00
  • Standard mail order N/A
Preferred Brand
  • Preferred cost-share mail order N/A
  • Standard retail $0.00
  • Standard mail order N/A
Annual Drug Deductible $0 (excludes Tiers 1, 2 and 3)
Preferred Generic
  • Preferred cost-share mail order N/A
  • Standard retail N/A
  • Standard mail order N/A
Generic
  • Preferred cost-share mail order N/A
  • Standard retail N/A
  • Standard mail order N/A
Preferred Brand
  • Preferred cost-share mail order N/A
  • Standard retail N/A
  • Standard mail order N/A
Annual Drug Deductible $0 (excludes Tiers 1, 2 and 3)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
Preferred Brand
  • Preferred cost-share mail order $0.00
  • Standard retail $0.00
  • Standard mail order $0.00
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