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2026 UHC Dual Complete VA-Y4 (PPO D-SNP)

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2025 UHC Dual Complete VA-Y4 (PPO D-SNP)

Medicare

What is a dual special needs plan?

H0421-001 -000

Monthly premium: $0.00 *

*Your costs may be as low as $0, depending on your level of Extra Help.

This Preferred Provider Organization (PPO) plan gives you more benefits than Original Medicare, all for a $0 plan premium. You'll keep all your Medicaid benefits, and add even more. For those who have full Medicaid benefits and are in managed care. After joining this plan, you'll also be enrolled in the UHC Community Plan - Cardinal Care for a combined Medicare and Medicaid experience: VA: FBDE, QMB PLUS, SLMB PLUS

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1-844-812-5967 TTY: 711 8 a.m.-8 p.m. local time, 7 days a week

Announcements from the Commonwealth about the Coronavirus (COVID-19) can be found below:

Governor Northam Outlines Plans for Novel Coronavirus (COVID-19) - March 4, 2020

Find providers and coverage for this plan.

Find a provider

Search for doctors, hospitals, and specialists.

Find behavioral health support

Search for providers, clinics and treatment centers.

Find a dentist

Find a dentist near you.

Find a pharmacy

Find a pharmacy near you.

View drug list

Find medications covered by this plan.

Benefits & features

$2,500 dental allowance for covered services like cleanings, fillings, x-rays and crowns

$205 credit every month for OTC, plus healthy food and utilities for qualifying members

$300 allowance for one pair of glasses or contacts, plus $0 copay for a routine eye exam

$2,200 allowance for a broad selection of OTC and brand-name hearing aids

$0 copay for 24 one-way trips to or from doctor visits and the pharmacy

No cost medical services

$0 copay for primary care, hospital stays and specialist visits

Routine foot care

4 foot care visits for nail trims and other covered preventive care

Prescription drug coverage

$0 copay for covered generic and brand-name prescriptions

Provider network

See any provider in our large provider network

NurseLine Services

Your 24-hour health information resource

Optum HouseCalls

Yearly in-home visit to help support your health

Benefits, features and/or devices may vary by plan/area.

Limitations, exclusions and/or network restrictions may apply.

OTC, food and utility benefits have expiration timeframes.

Review your Evidence of Coverage (EOC) for more information.

The healthy food and utilities benefit is a special supplemental benefit only available to chronically ill enrollees with a qualifying condition, such as diabetes, cardiovascular disorders, chronic heart failure, chronic high blood pressure and/or chronic high cholesterol, and who also meet all applicable plan coverage criteria. There may be other qualified chronic conditions not listed.

If your plan offers out-of-network dental coverage and you see an out-of-network dentist, you might be billed more. Network size varies by local market.

Review your plan Drug List (Formulary) on UHC.com/Medicare for a list of covered prescription drugs, including those on Tier 1.

Annual routine eye exam and an allowance for contacts or one pair of frames, with standard (single, bi-focal, tri-focal or standard progressive) lenses covered in full every year. Review your Evidence of Coverage (EOC) for more information.

The plan only covers hearing aids from a UnitedHealthcare Hearing network provider. Other hearing exam providers are available in the UnitedHealthcare network.

,Network size varies by local market and exclusions may apply.

Referrals may be needed to see network specialists.

Routine transportation not for use in emergencies.

A trip is one-way and roundtrip is two trips.

Optum HouseCalls may not be available in all areas.

UHC Dual Complete VA-Y4 (PPO D-SNP)

Monthly plan premium for people who get Extra Help from Medicare to help pay for their prescription drug costs

If you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine your total monthly plan premium as a member of our Plan.

This table shows you what your monthly plan premium will be if you get Extra Help.

Your level of Extra Help Monthly premium*
100% $0.00

*This does not include any Medicare Part B premium you may have to pay.

If you aren’t getting Extra Help, you can see if you qualify by calling:

Your health care needs are unique. These documents can help you make sure you get the right coverage.

Documents include Annual Notice of Changes, Evidence of Coverage, Formularies, Medicare Plan Star Ratings, Provider Directories, Summary of Benefits, Other downloadable resources.

Downloadable resources (opens modal window)

Member resources

View available resources (opens modal window)

H0421_CSWEBSITE_M_2026

Disclaimer

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ooking for the federal government’s Medicaid website? Look here at Medicaid.govOpens in a new tab.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only. Access to this service is subject to terms of use.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2025.

Formularies

The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.