UHC Dual Complete MD-Q001 (D-SNP) Plan Details for Talbot County, MD
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*CMS rated this UnitedHealthcare plan (H7464-012-0) 3.5 (Above Average) out of 5 stars.
UHC Dual Complete MD-Q001 (D-SNP) is a Dual-Eligible Medicare Special Needs Plan. The 2025 Annual Enrollment period starts October 15. Plan benefits begin January 1.
The delivery of healthcare services and costs by UnitedHealthcare is different than Original Medicare. This private health insurance option may include additional benefits that are not provided by Medicare Part A and Part B.
Only individuals who meet all Dual-Eligible SNP qualification requirements are eligible to join this D-SNP plan.
| Plan Basics | |
|---|---|
| Plan ID: | H7464-012-0 |
| Plan Type: | HMO-POS D-SNP |
| Plan Year: | 2025 |
| Premium: | $0.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | 9,350.00 /yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | $590.00 deductible |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Talbot County, MD |
| Insured By: | UnitedHealthcare |
| Summary of Benefits |
|---|
Health Plan Cost Sharing & Benefits
The following table is a summary of the most common out-of-pocket costs you will incur if you join this UnitedHealthcare plan:
| Healthcare Service | Member Cost |
|---|---|
| Doctor Visits (In-Network) | |
| Primary: | 20% Coinsurance |
| Specialist: | 20% Coinsurance Prior Authorization Required |
| Preventive care: | $0 Copay |
| Foot Care (In-Network) | |
| Foot exams and treatment (Medicare-covered): | 20% Coinsurance Prior Authorization Required |
| Routine foot care: | $0 Copay Prior Authorization Required |
| Chiropractic Care (In-Network) | |
| Medicare-covered chiropractic care: | 20% Coinsurance Prior Authorization Required |
| Routine chiropractic care: | $0 |
| Emergency Care / Urgent Care | |
| Emergency room care: | $110 Copay |
| Urgent care: | $45 Copay |
| Ground ambulance: | 20% Coinsurance |
| Inpatient hospital coverage: | $1,535.00 per stay |
| Outpatient hospital coverage: | 20% Coinsurance Prior Authorization Required |
| Skilled Nursing Facility: | |
| Optional supplemental benefits: | Not Covered |
| Mental Health Services (In-Network) | |
| Outpatient individual therapy visit with a psychiatrist: | 20% Coinsurance |
| Outpatient group therapy visit with a psychiatrist: | 20% Coinsurance |
| Inpatient hospital - psychiatric: | $1,535.00 per stay |
| Outpatient group therapy visit: | 20% Coinsurance |
| Outpatient individual therapy visit: | 20% Coinsurance Prior Authorization Required |
| Rehabilitation Services (In-Network) | |
| Physical therapy and speech and language therapy visit: | 20% Coinsurance Prior Authorization Required |
| Occupational therapy visit: | 20% Coinsurance Prior Authorization Required |
| Medical Equipment / Supplies (In-Network) | |
| Diabetes supplies: | $0 Copay Prior Authorization Required |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
| Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
| Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
| Diagnostic radiology services (e.g., MRI): | 20% Coinsurance Prior Authorization Required |
| Lab services: | $0 Copay Prior Authorization Required |
| Outpatient x-rays: | 20% Coinsurance Prior Authorization Required |
| Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required |
| Medicare Part B Drugs (In-Network) | |
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our UHC Dual Complete MD-Q001 Summary of Benefits information.
Supplemental Health Plan Benefits (H7464-012-0)
The following is a summary of the supplemental benefits UnitedHealthcare includes with this plan:
| Supplemental Healthcare Service | Member Cost |
|---|---|
| Preventive Dental | |
| Oral exam (In-Network) | Not Covered |
| Fluoride treatment (In-Network) | Not Covered |
| Dental x-ray(s) (In-Network) | Not Covered |
| Cleaning (In-Network) | Not Covered |
| Comprehensive Dental | |
| Periodontics (In-Network) | Not Covered |
| Non-routine services (In-Network) | Not Covered |
| Diagnostic services (In-Network) | Not Covered |
| Extractions (In-Network) | Not Covered |
| Endodontics (In-Network) | Not Covered |
| Restorative services (In-Network) | Not Covered |
| Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
| Hearing | |
| Fitting/evaluation (In-Network) | Covered Limits may apply |
| Hearing aids (In-Network) | Covered Limits may apply |
| Hearing exam (In-Network) | Not Covered |
| Vision | Maximum vision benefit: | $2.00 Every three years |
| Eyeglasses (frames and lenses) (In-Network) | Not Covered |
| Routine eye exam (In-Network) | $0 Copay |
| Contact lenses (In-Network) | Not Covered |
Prescription Drug Plan Costs & 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 details of this plan's prescription drug plan premium.
| Basic Part D Premium: | |
| Supplemental Part D Premium: | |
| Total Part D Premium: | |
| Part D Premium with Full LIS Assistance: |
The Social Security Extra Help page has more information about the low-income subsidy (LIS) and how to enroll in the program.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. 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, UHC Dual Complete MD-Q001 has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Preferred | Standard |
|---|---|---|
| $0 copay on all covered generic and brand-name prescriptions. | ||
CMS 5-Star Rating Marks
Each year CMS rates Medicare Special Needs Plans in nine broad categories based on a 5-star system. The table below shows the quality ratings for this UnitedHealthcare plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- UHC Dual Complete MD-V001
- UHC Dual Complete MD-Q001
- UHC Dual Complete MD-S002
- UHC Dual Choice DC-Y001
- UHC Dual Complete MD-S002
Contact UnitedHealthcare
| Plan Website: | http://UHC.com/CommunityPlan |
|---|---|
| Formulay Information: | http://UHC.com/CommunityPlan |
| Pharmacy Information: | UnitedHealthcare Pharmacy Page |
| Prospective Members: | (888)834-3721 |
| TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Health Plan Compatibility
Medicare Advantage Special Need Plans are not compatible with most other forms of health insurance. If you have Medicare Part A and/or Medicare Part B and join a SNP plan, you will be disenrolled from Original Medicare. You cannot simultaneously enroll in an SNP plan and Medicare Supplement Insurance.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- UnitedHealthcare, http://UHC.com/CommunityPlan, Last Accessed October 13, 2023
- Medicaid.gov, "Medicaid & CHIP in Maryland", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.