UnitedHealthcare Dual Complete: A Comprehensive Guide to Benefits and Coverage

 

UnitedHealthcare Dual Complete: A Comprehensive Guide to Benefits and Coverage

UnitedHealthcare Dual Complete is a Medicare Advantage plan that is designed for individuals who are eligible for both Medicare and Medicaid. The plan offers a wide range of benefits and features that are not available with Original Medicare, making it an attractive option for those who need additional coverage. With UnitedHealthcare Dual Complete, members can enjoy comprehensive healthcare coverage, including medical, dental, vision, and prescription drug benefits.

Understanding UnitedHealthcare Dual Complete is essential for those who are considering enrolling in this plan. The plan is designed to provide comprehensive coverage for individuals who are eligible for both Medicare and Medicaid, so it is important to understand the benefits and limitations of the plan before making a decision. UnitedHealthcare Dual Complete offers a range of benefits and features that are not available with Original Medicare, including dental and vision coverage, prescription drug benefits, and more.

Benefits of UnitedHealthcare Dual Complete include comprehensive healthcare coverage, access to a large network of providers, and extra benefits like transportation to medical appointments and fitness programs. Eligibility and enrollment requirements vary depending on the state, so it is important to check with your local UnitedHealthcare representative to determine if you are eligible to enroll in the plan. With UnitedHealthcare Dual Complete, members can enjoy peace of mind knowing that they have access to comprehensive healthcare coverage that meets their unique needs.

Key Takeaways

  • UnitedHealthcare Dual Complete is a Medicare Advantage plan designed for individuals who are eligible for both Medicare and Medicaid.
  • The plan offers comprehensive healthcare coverage, including medical, dental, vision, and prescription drug benefits.
  • Benefits of UnitedHealthcare Dual Complete include access to a large network of providers, extra benefits like transportation to medical appointments and fitness programs, and more.

Understanding UnitedHealthcare Dual Complete

UnitedHealthcare Dual Complete is a Medicare Special Needs Plan (SNP) designed for individuals who are eligible for both Medicare and Medicaid. These individuals are known as dual eligibles. Dual eligibles are typically low-income seniors, people with disabilities, and those with chronic health conditions.

UnitedHealthcare Dual Complete provides comprehensive healthcare coverage, including medical, hospital, prescription drug, and extra benefits like dental, vision, and hearing. Members of this plan can also access care coordination services to help them navigate the complex healthcare system.

To be eligible for UnitedHealthcare Dual Complete, one must have both Medicare and Medicaid coverage. In North Carolina, eligible categories include FBDE, QDWI, QI, QMB, QMB PLUS, SLMB, and SLMB PLUS.

This plan offers a range of benefits, including $0 copays for many preventive services, no-cost transportation to medical appointments, and access to a 24/7 nurse advice line. Members can also receive a free gym membership and discounts on healthy living programs and products.

Overall, UnitedHealthcare Dual Complete is a comprehensive healthcare plan designed to meet the unique needs of dual eligibles. It provides access to quality healthcare services and extra benefits to help members improve their health and well-being.

Benefits of UnitedHealthcare Dual Complete

UnitedHealthcare Dual Complete is a Medicare Advantage Special Needs Plan designed for individuals who are eligible for both Medicare and Medicaid. The plan provides comprehensive coverage that includes all the benefits of Original Medicare, as well as additional benefits at no extra cost.

Some of the benefits of UnitedHealthcare Dual Complete include:

Extra Benefits

UnitedHealthcare Dual Complete plans offer many extra benefits and features that are not available with Original Medicare. These benefits vary by plan and may include:

  • Dental coverage
  • Vision coverage
  • Hearing coverage
  • Prescription drug coverage
  • Transportation services
  • Over-the-counter (OTC) items
  • Fitness benefits
  • Meal delivery services

$0 Premium

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy). This means that eligible individuals can enroll in a UnitedHealthcare Dual Complete plan and enjoy comprehensive coverage without paying any additional premiums.

Care Coordination

UnitedHealthcare Dual Complete plans provide care coordination services to help members manage their healthcare needs. This includes access to a care coordinator who can help members schedule appointments, find healthcare providers, and coordinate care between different providers.

Flexibility

UnitedHealthcare Dual Complete plans offer flexibility in terms of choosing healthcare providers. Members can choose from a large network of healthcare providers, including doctors, hospitals, and specialists. In addition, members have the option to receive care from out-of-network providers, although this may result in higher out-of-pocket costs.

Overall, UnitedHealthcare Dual Complete plans provide comprehensive coverage that includes many extra benefits and features at no additional cost. With $0 premiums for eligible individuals and care coordination services, UnitedHealthcare Dual Complete is an excellent option for those who are eligible for both Medicare and Medicaid.

Eligibility and Enrollment

To be eligible for UnitedHealthcare Dual Complete (HMO-POS D-SNP), an individual must be eligible for Medicare and have full or partial Medicaid coverage in one of the following categories: FBDE, QDWI, QI, QMB, QMB PLUS, SLMB, SLMB PLUS.

Dual-eligible individuals can enroll in a Dual Special Needs Plan (D-SNP), which is a type of Medicare Advantage plan. D-SNPs are designed to meet the unique needs of individuals who are eligible for both Medicare and Medicaid.

To enroll in a D-SNP, individuals must have both Medicare Parts A and B (Original Medicare) and live in the coverage area of the D-SNP. Enrollment in a D-SNP is typically done during the Annual Enrollment Period (AEP), which runs from October 15th to December 7th each year.

In addition to the AEP, individuals who are newly eligible for Medicare and Medicaid, or who experience a qualifying life event, may be eligible for a Special Enrollment Period (SEP) to enroll in a D-SNP outside of the AEP.

It is important to note that D-SNPs are offered by private insurance companies, such as UnitedHealthcare, and not directly through Medicare or Medicaid. Therefore, the benefits and costs of D-SNPs may vary by plan and by state. It is recommended that individuals review plan information carefully before enrolling in a D-SNP.

Overall, UnitedHealthcare Dual Complete (HMO-POS D-SNP) is an option for dual-eligible individuals who are looking for a Medicare Advantage plan that is tailored to their unique needs. Eligibility and enrollment requirements should be carefully reviewed to determine if this plan is the right fit.

Coverage and Services

UnitedHealthcare Dual Complete is a Dual Special Needs Plan (D-SNP) that provides coverage and services for people who have both Medicare and Medicaid. The plan offers a wide range of benefits, including prescription drug coverage, medical services, and dental, vision, and hearing benefits.

Prescription Drugs

UnitedHealthcare Dual Complete provides comprehensive prescription drug coverage. The plan covers a broad range of medications, including generic and brand-name drugs. Members have access to a large network of pharmacies, including many major retail chains.

Medical Services

UnitedHealthcare Dual Complete covers a wide range of medical services, including doctor visits, hospital stays, and emergency care. The plan also provides coverage for preventive care, such as annual wellness visits and cancer screenings. Members have access to a large network of healthcare providers, including primary care physicians, specialists, and hospitals.

Dental, Vision and Hearing

UnitedHealthcare Dual Complete provides coverage for dental, vision, and hearing services. The plan covers routine dental care, including cleanings and exams, as well as more extensive dental procedures, such as fillings and extractions. Members also have access to vision services, including eye exams, glasses, and contacts. The plan also covers hearing aids and related services.

Overall, UnitedHealthcare Dual Complete provides comprehensive coverage and services for people who have both Medicare and Medicaid. The plan offers a wide range of benefits, including prescription drug coverage, medical services, and dental, vision, and hearing benefits. Members have access to a large network of healthcare providers and pharmacies, making it easy to get the care they need.

Cost and Payment Options

UnitedHealthcare Dual Complete plans offer a range of cost and payment options to suit different budgets and healthcare needs. Monthly premiums for these plans vary by location, plan type, and other factors.

One of the benefits of UnitedHealthcare Dual Complete plans is that many plans have a $0 monthly premium. This makes them an affordable option for people who are eligible for both Medicare and Medicaid. In addition to the monthly premium, there may be other costs associated with the plan, such as copayments, coinsurance, and deductibles.

UnitedHealthcare Dual Complete plans also offer a range of payment options to make it easy for members to pay their premiums. Members can choose to have their premiums deducted from their Social Security or Railroad Retirement Board benefit, or they can pay by check, money order, or electronic funds transfer. Members can also choose to set up automatic payments to ensure that their premiums are paid on time each month.

Overall, UnitedHealthcare Dual Complete plans offer a range of cost and payment options to make healthcare more affordable and accessible for people who are eligible for both Medicare and Medicaid.

How to Use the Plan

UnitedHealthcare Dual Complete is a Medicare Advantage D-SNP for Full-Benefit Dual-Eligible (FBDE) beneficiaries, qualified Medicare dual-eligible beneficiaries (QMBs), and partial dual-eligible beneficiaries (partial). If you are eligible for this plan, here is how you can use it:

Find In-Network Providers

The first step is to find in-network providers. UnitedHealthcare Dual Complete offers a wide network of healthcare providers, including doctors, specialists, hospitals, and pharmacies. You can use the plan's online directory to search for in-network providers in your area. Alternatively, you can call the plan's customer service number to get help finding a provider.

Make an Appointment

Once you have found an in-network provider, you can make an appointment. You will need to present your UnitedHealthcare Dual Complete member ID card at the time of the appointment. The provider will then bill the plan directly for the services you receive.

Understand Your Benefits

It is important to understand your benefits before using the plan. UnitedHealthcare Dual Complete offers a range of benefits, including medical, prescription drug, dental, vision, and hearing coverage. Some benefits may require prior authorization or have limitations and restrictions. You can review your plan's Summary of Benefits to understand what is covered and what is not.

Use Value-Added Services

UnitedHealthcare Dual Complete also offers value-added services, such as transportation to and from medical appointments, meal delivery, and wellness programs. These services are designed to help you stay healthy and independent. You can contact the plan's customer service to learn more about these services and how to use them.

Contact Customer Service

If you have any questions or need help using your UnitedHealthcare Dual Complete plan, you can contact the plan's customer service. The customer service representatives are available to help you with any issues or concerns you may have. You can find the customer service number on the back of your member ID card.

Provider Network

UnitedHealthcare Dual Complete has a large network of providers, including primary care physicians, specialists, hospitals, and other healthcare professionals. These providers have contracted with UnitedHealthcare to offer services to members of the plan.

To find a provider, members can use the online directory available on the UnitedHealthcare website. This directory includes information about each provider, such as their name, address, phone number, and specialty. Members can also search for providers by location, name, or specialty.

In addition to the online directory, members can also call UnitedHealthcare customer service to find a provider. The customer service representative can provide information about providers in the member's area and help them schedule an appointment.

UnitedHealthcare Dual Complete also offers access to a variety of healthcare services, including preventive care, diagnostic tests, and treatment for acute and chronic conditions. Members can receive care from in-network providers without needing a referral from their primary care physician.

Overall, UnitedHealthcare Dual Complete offers a comprehensive network of providers and healthcare services to help members get the care they need.

Customer Support

UnitedHealthcare Dual Complete offers various customer support options to assist its members with their healthcare needs. Members can contact UnitedHealthcare customer service representatives via phone, online, or by mail.

For Medicare Advantage, prescription drug, or Medicaid questions, members can call the number on their ID card. For Medicare supplement plans, members can call 1-800-523-5800. For plans through work, members can call 1-866-801-4409.

UnitedHealthcare also offers a live chat option through their One Healthcare ID. Members can access the United Healthcare Provider Portal self-service tools and get technical assistance through this platform.

For Dual Special Needs Plan (D-SNP) Medicare questions, members can call 1-844-812-5967. TTY service is also available for members who are deaf or hard of hearing.

UnitedHealthcare's customer service representatives are available 8 a.m. to 8 p.m., 7 days a week. Members can also send mail to UnitedHealthcare at the address listed on their ID card.

Overall, UnitedHealthcare Dual Complete offers multiple customer support options to ensure their members receive the assistance they need to manage their healthcare.

Plan Limitations and Exclusions

While UnitedHealthcare Dual Complete plans offer a range of benefits to eligible individuals, there are some limitations and exclusions to keep in mind. These limitations and exclusions may vary depending on the specific plan and location, so it's important to review the plan details carefully.

One common limitation is the requirement to use in-network providers. With some exceptions, individuals may be responsible for paying the full cost of care received from out-of-network providers. Additionally, some plans may require prior authorization for certain services or treatments.

Another important consideration is the prescription drug coverage offered by the plan. While most plans cover a wide range of medications, there may be limitations on the quantity or frequency of prescriptions that can be filled. Some plans may also require prior authorization for certain medications or may have restrictions on certain types of drugs.

It's also important to note that not all services and treatments are covered by UnitedHealthcare Dual Complete plans. Some common exclusions include cosmetic procedures, experimental treatments, and non-medically necessary services. Additionally, plans may have limits on the number of certain services, such as physical therapy or chiropractic care, that can be received in a given period.

Overall, while UnitedHealthcare Dual Complete plans offer many benefits to eligible individuals, it's important to carefully review the plan details and limitations to ensure that the plan meets individual healthcare needs.

Frequently Asked Questions

What is UnitedHealthcare Dual Complete?

UnitedHealthcare Dual Complete is a Medicare Advantage plan that combines medical and prescription drug coverage into one plan. It is designed for people who are eligible for both Medicare and Medicaid, also known as dual-eligibles. The plan offers additional benefits such as dental, vision, and hearing coverage, as well as wellness programs.

Does United Healthcare have a flex card?

Yes, United Healthcare offers a flex card, also known as a health savings account (HSA) debit card. It allows members to pay for eligible healthcare expenses with pre-tax dollars. The flex card can be used at eligible healthcare providers and pharmacies.

What is a dual eligible special needs plan D SNP quizlet?

A Dual Eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage plan that is specifically designed for individuals who are eligible for both Medicare and Medicaid. D-SNPs provide additional benefits and services beyond what is covered by Original Medicare, such as dental, vision, and hearing coverage. Quizlet is an online learning platform that offers study tools, flashcards, and practice tests.

What are the benefits of UnitedHealthcare Dual Complete Plan 1?

UnitedHealthcare Dual Complete Plan 1 offers a variety of benefits, including medical and prescription drug coverage, dental, vision, and hearing coverage, as well as wellness programs. The plan also offers transportation services to and from medical appointments, and an over-the-counter allowance for eligible items.

How do I find a UnitedHealthcare Dual Complete TN provider?

To find a UnitedHealthcare Dual Complete provider in Tennessee, members can use the "Find a Doctor" tool on the UnitedHealthcare website. They can search by zip code, provider name, or specialty. Members can also call customer service for assistance in finding a provider.

What dental services are covered by UnitedHealthcare Dual Complete?

UnitedHealthcare Dual Complete offers a variety of dental services, including routine cleanings, fillings, extractions, and dentures. Some plans also offer coverage for orthodontic services. Members should check their specific plan benefits to see what dental services are covered.

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