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UHC Dual Complete VA-S002 (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H7464-001
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Monthly Premium
UHC Dual Complete VA-S002 (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H7464-001
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
UHC Dual Complete VA-S002 (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H7464-001
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
$0.00
Monthly Premium
Virginia Counties Served
Roanoke Virginia Beach City Spotsylvania Portsmouth City Harrisonburg City Chesapeake City Dickenson Covington City Fauquier Botetourt Prince Edward Augusta Hampton City Lunenburg Manassas City Carroll Fredericksburg City Petersburg City Salem Loudoun Hanover Albemarle Fairfax Scott Alexandria City Emporia City Norfolk City Williamsburg City Wythe Montgomery Bristol City Frederick Orange Floyd Suffolk City Louisa Stafford Rappahannock Franklin City King and Queen Alleghany Grayson Amherst Mecklenburg Manassas Park City Waynesboro City Patrick Radford Sussex Prince George Shenandoah King George Russell Southampton Norton City Culpeper Essex Richmond City Poquoson City Appomattox Buckingham Fluvanna Surry Charles City Amelia Rockingham Pittsylvania Rockbridge Colonial Heights City Campbell Bland Chesterfield Winchester City Charlottesville City Craig Bath Bedford Roanoke City Giles Northampton Middlesex Isle of Wight Greene Greensville Washington Henrico Danville City Hopewell City Warren Falls Church City Richmond Brunswick Lexington City Page New Kent Caroline Arlington Prince William Mathews Lynchburg City James City Jefferson Martinsville City Dinwiddie Franklin Galax City King William Lancaster Newport News City Wise Accomack Powhatan Fairfax City Madison Henry York Northumberland Westmoreland Nelson Pulaski Smyth Gloucester Halifax Buena Vista City Staunton City Highland Nottoway Cumberland Tazewell Goochland Lee Clarke Buchanan
Basic Costs and Coverage
Coverage | Cost |
---|---|
Monthly Deductible | $0 |
Out of Pocket Max | In-Network: $8850 Out-of-Network: N/A |
Initial Coverage Limit | $5030 |
Catastrophic Coverage Limit | $8,000 |
Primary Care Doctor Visit | In-Network: Doctor Office Visit: |
Specialty Doctor Visit | In-Network: Doctor Specialty Visit: |
Inpatient Hospital Care | In-Network: Acute Hospital Services: |
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: |
Emergency Room Visit | Copayment for Emergency Care $0.00 Worldwide Coverage: |
Ambulance Transportation | In-Network: Ground Ambulance: Air Ambulance: Benefit Details - General 10a Note - NOTE ON AUTHORIZATION: Authorization is required for Non-emergency Medicare-covered ambulance ground and air transportation. Emergency Ambulance does not require authorization. |
Health Care Services and Medical Supplies
UHC Dual Complete VA-S002 (HMO-POS 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:
Prior Authorization Required for Chiropractic Services |
Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: |
Durable Medical Eqipment (DME) | In-Network: |
Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Outpatient Diag/Therapeutic Rad Services: |
Home Health Care | In-Network: |
Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: |
Mental Health Outpatient Care | In-Network: |
Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Outpatient Observation Services: Ambulatory Surgical Center Services: |
Outpatient Substance Abuse Care | In-Network: |
Over-the-counter (OTC) Items | In-Network: Over-The-Counter (OTC) Items: |
Podiatry Services | In-Network:
Prior Authorization Required for Podiatry Services |
Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: |
Dental Benefits
The following dental services are covered from in-network providers.
Coverage | Cost |
---|---|
Dental Care | In-Network: Preventive Dental:
Copayment for Prophylaxis (Cleaning) $0.00
Copayment for Fluoride Treatment $0.00
Copayment for Dental X-Rays $0.00
Maximum Plan Benefit of $3000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined Comprehensive Dental:
Copayment for Restorative Services $0.00
Copayment for Endodontics $0.00
Copayment for Periodontics $0.00
Copayment for Extractions $0.00
Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00
Maximum Plan Benefit of $3000.00 every year for Preventive and Non-Medicare Covered Comprehensive combined POS (Out-of-Network): Non-Medicare Covered Dental Services: |
Vision Benefits
The following vision services are covered from in-network providers.
Coverage | Cost |
---|---|
Vision Benefits | In-Network: Eye Exams:
Prior Authorization Required for Eye Exams Eyewear:
Copayment for Eyeglass Frames $0.00
Maximum Plan Benefit of $400.00 every year for all Non-Medicare covered eyewear |
Hearing Benefits
The following hearing services are covered from in-network providers.
Coverage | Cost |
---|---|
Hearing Benefits | In-Network: Hearing Exams:
Prior Authorization Required for Hearing Exams Hearing Aids:
Maximum Plan Benefit of $3600.00 every year both ears combined |
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 | In-Network: Abdominal aortic aneurysm screening
Tobacco use cessation |
Prescription Drug Costs and Coverage
The UHC Dual Complete VA-S002 (HMO-POS D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $0 per year.
Coverage | Cost |
---|---|
Coverage & Cost | |
Annual Drug Deductible | $0 |
Preferred Generic |
|
Generic |
|
Preferred Brand |
|
Non-Preferred Drug |
|
Specialty Tier |
|
Annual Drug Deductible | $0 |
Preferred Generic |
|
Generic |
|
Preferred Brand |
|
Non-Preferred Drug |
|
Specialty Tier |
|
Annual Drug Deductible | $0 |
Preferred Generic |
|
Generic |
|
Preferred Brand |
|
Non-Preferred Drug |
|
Specialty Tier |
|
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