UHC Dual Complete KY-S001 (PPO D-SNP)
UHC Dual Complete KY-S001 (PPO D-SNP) H1889-008 Plan Details
UHC Dual Complete KY-S001 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H1889-008
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.
$0.00
Monthly Premium
UHC Dual Complete KY-S001 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H1889-008
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.
UHC Dual Complete KY-S001 (PPO D-SNP) H1889-008 Plan Details
UHC Dual Complete KY-S001 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare
Plan ID: H1889-008
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.
$0.00
Monthly Premium
Kentucky Counties Served
Henry
Anderson
Carroll
Marion
Washington
Nelson
Casey
Trimble
Shelby
Franklin
Spencer
Hardin
Taylor
Oldham
Jefferson
Bullitt
Larue
Meade
Breckinridge
Ohio
Grayson
Estill
Harrison
Bourbon
Bath
Robertson
Jackson
Elliott
Owen
Rowan
Clark
Scott
Menifee
Lee
Powell
Wolfe
Whitley
Nicholas
Mercer
Fayette
Montgomery
Boyle
Jessamine
Woodford
Carter
Adair
Bell
Madison
Morgan
Garrard
Rockcastle
Pulaski
Lincoln
Pickett
Clay
Owsley
Laurel
Knox
Harlan
Leslie
Mccreary
Letcher
Perry
Bracken
Lawrence
Mason
Fleming
Greenup
Gallatin
Lewis
Claiborne
Breathitt
Boyd
Johnson
Martin
Floyd
Knott
Magoffin
Pike
Mccracken
Calloway
Carlisle
Metcalfe
Christian
Graves
Fulton
Hickman
Ballard
Marshall
Allen
Crittenden
Livingston
Lyon
Trigg
Caldwell
Warren
Hart
Simpson
Butler
Barren
Henderson
Hancock
Muhlenberg
Edmonson
Daviess
Monroe
Cumberland
Logan
Todd
Green
Union
Mclean
Clinton
Webster
Hopkins
Wayne
Russell
Campbell
Grant
Boone
Pendleton
Kenton
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $9350 Out-of-Network: N/A |
| Initial Coverage Limit | $2000 |
| Catastrophic Coverage Limit | $2,000 |
| Primary Care Doctor Visit | In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0 Note: $0 copayment applies to Medicare covered telehealth, Medicare covered remote monitoring, and visits conducted in the member's home. The higher cost share applies to all other Medicare covered services. |
| Specialty Doctor Visit | In Network In-Network: Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $0 Prior Authorization Required for Doctor Specialty Visit Note: $0 copayment applies to Medicare covered telehealth and Medicare covered remote monitoring. The higher cost share applies to all other Medicare covered services. Out of Network Out-of-Network: Doctor Specialty Visit Services: Coinsurance for Medicare Covered Physician Specialist Office Visit 0% or 20% Note: $0 copayment applies to Medicare covered telehealth and Medicare covered remote monitoring. The higher cost share applies to all other Medicare covered services. Prior authorization required |
| Inpatient Hospital Care | In Network In-Network: Acute Hospital Services: Copayment for Acute Hospital Services per Stay $0 Prior Authorization Required for Acute Hospital Services 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. Out of Network Out-of-Network: Acute Hospital Services: Coinsurance for Acute Hospital Services per Stay 0% or 20% 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. Prior authorization required |
| Urgent Care | Copayment for Urgent Care $0 Note: $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 |
| Emergency Room Visit | Copayment for Emergency Care $0 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $0 Copayment for Worldwide Emergency Transportation $0 |
| Ambulance Transportation | In Network In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $0 Air Ambulance: Copayment for Air Ambulance Services $0 Prior Authorization Required for Air Ambulance Out of Network Out-of-Network: Ambulance Services: Coinsurance for Medicare Covered Ambulance Services - Ground 0% or 20% Coinsurance for Medicare Covered Ambulance Services - Air 0% or 20% Prior authorization required |
Health Care Services and Medical Supplies
UHC Dual Complete KY-S001 (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 In-Network: Copayment for Medicare-covered Chiropractic Services $0 Prior Authorization Required for Chiropractic Services Out of Network Out-of-Network: Medicare Covered Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 0% or 20% Prior authorization required |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In Network In-Network: Copayment for Medicare-covered Diabetic Supplies $0 Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0 Out of Network Out-of-Network: Medicare Covered Diabetic Supplies and Services: Coinsurance for Medicare Covered Diabetic Supplies 0% or 40% Coinsurance for Medicare Covered Diabetic Therapeutic Shoes or Inserts 0% or 40% |
| Durable Medical Eqipment (DME) | In Network In-Network: Copayment for Medicare-covered Durable Medical Equipment $0 Prior Authorization Required for Durable Medical Equipment Out of Network Out-of-Network: Medicare Covered Durable Medical Equipment Services: Coinsurance for Medicare Covered Durable Medical Equipment 0% or 40% Prior authorization required |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Diagnostic Tests and Procedures: $0 copay Lab Services: $0 copay Diagnostic Radiology Services: $0 copay X-rays: $0 copay |
| Home Health Care | In Network In-Network: Copayment for Medicare-covered Home Health Services $0 Prior Authorization Required for Home Health Services Out of Network Out-of-Network: Medicare Covered Home Health Services: Coinsurance for Medicare Covered Home Health 0% or 40% Prior authorization required |
| Mental Health Inpatient Care | In Network In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $0 Prior Authorization Required for Psychiatric Hospital Services 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. Out of Network Out-of-Network: Psychiatric Hospital Services: Coinsurance for Psychiatric Hospital per Stay 0% or 20% 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. Prior authorization required |
| Mental Health Outpatient Care | In Network In-Network: Copayment for Medicare-covered Individual Sessions $0 Copayment for Medicare-covered Group Sessions $0 Out of Network Out-of-Network: Medicare Covered Mental Health Services: Coinsurance for Medicare Covered Individual Sessions 0% or 20% Coinsurance for Medicare Covered Group Sessions 0% or 20% |
| Outpatient Services / Surgery | In Network In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 Prior Authorization Required for Outpatient Hospital Services Note: $0 copayment for outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures.Note: Benefit category includes both the facility and professional component. Outpatient Observation Services: Copayment for Medicare Covered Observation Services $0 Prior Authorization Required for Outpatient Observation Services Benefit Details - General 9a2 Note - NOTE ON OBSERVATION SERVICES: Benefit category includes both the facility and professional component. Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0 Prior Authorization Required for Ambulatory Surgical Center Services Benefit Details - General 9b Note - NOTE ON ASC SERVICES: Benefit category 9b includes both the facility and professional component.Benefit Details - General 9b Note - NOTE ON COST SHARING RANGE FOR ASC Services: $0 copayment for outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures. Out of Network Out-of-Network: Medicare Covered Outpatient Hospital Services: Coinsurance for Medicare Covered Outpatient Hospital Services 0% or 20% Coinsurance for Medicare Covered Ambulatory Surgical Center Services 0% or 20% Note: $0 copayment for outpatient diagnostic colonoscopies. The higher cost share applies to all other outpatient procedures.Note: Benefit category includes both the facility and professional component. Prior authorization required |
| Outpatient Substance Abuse Care | In Network In-Network: Copayment for Medicare-covered Individual Sessions $0 Copayment for Medicare-covered Group Sessions $0 Prior Authorization Required for Outpatient Substance Abuse Services Note: $0 copayment applies to Medicare covered telehealth for individual sessions. The higher cost share applies to all other Medicare covered services. Out of Network Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 0% or 20% Coinsurance for Medicare Covered Group Sessions 0% or 20% Note: $0 copayment applies to Medicare covered telehealth for individual sessions. The higher cost share applies to all other Medicare covered services. Prior authorization required |
| Over-the-counter (OTC) Items | In Network In-Network: Over-The-Counter (OTC) Items: Copayment for Over-The-Counter (OTC) Items $0 Note: Plan offers a monthly benefit credit that can be used to either purchase items from a catalog and/or a retail card allowing members to receive Over The Counter healthcare items. Out of Network Out-of-Network: Non-Medicare Covered Over-The-Counter (OTC) Items Services: Copayment for Non-Medicare Covered Over-The-Counter (OTC) Items $0 |
| Podiatry Services | In Network In-Network: Copayment for Medicare-Covered Podiatry Services $0 Copayment for Routine Foot Care $0
Out of Network Out-of-Network: Medicare Covered Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 0% or 20% Non-Medicare Covered Podiatry Services: Coinsurance for Non-Medicare Covered Podiatry Services 0% or 20% Prior authorization required |
| Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: Copayment for Skilled Nursing Facility Services per Stay $0 Prior Authorization Required for Skilled Nursing Facility Services Prior authorization required |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | $2,000 per year for covered dental services $0 copay for covered network preventive services such as oral exams, routine cleanings, X-rays and fluoride $0 copay for covered network comprehensive services such as fillings, crowns, root canals, extractions, bridges and dentures You will have access to Medicare Advantage's largest dental network, or you can choose any dentist. Seeing a network dentist may save you money. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | Routine Eye Exam: $0 copay, 1 per year |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In Network In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $0 Copayment for Routine Hearing Exams $0
Hearing Aids: Copayment for Hearing Aids $0
Out of Network Out-of-Network: Medicare Covered Hearing Exams Services: Coinsurance for Medicare Covered Hearing Exams 0% or 20% Prior authorization required |
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 In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots:
Yearly "Wellness" visit Out of Network Out-of-Network: Medicare Covered Medicare-covered Preventive Services: Coinsurance for Medicare Covered Medicare-covered Preventive Services 0% to 40% |
