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UnitedHealthcare Dual Complete® (HMO-POS D-SNP)

CMS Rating 5 out of 5 stars.

Medicare

What is a dual special needs plan?

H5253-041 -000

Monthly premium: $0.00 *

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

North Carolina 2023 UnitedHealthcare Dual Complete® (HMO-POS D-SNP) H5253-041-000

This Health Maintenance Organization (HMO) 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.

  • Check Eligibility (opens modal window)
  • UnitedHealthcare Dual Complete® (HMO-POS D-SNP)

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.

View Drug List

Find medications covered by this plan.

Find a Dentist

Find a dentist near you.

Find a Pharmacy

Find a pharmacy near you.

Benefits & Features

$220 a month on a prepaid card for OTC products and covered groceries at many retailers or online for home delivery. Learn more about this benefit

Up to $3500 for covered dental such as exams, x-rays, cleanings, fillings, crowns, root canals, extractions, and dentures. Learn more about this benefit

$0 copay on yearly routine eye exam and $300 allowance for frames or contacts plus free standard prescription lenses. Learn more about this benefit

$0 copay for 48 one-way rides to or from non-emergency medical doctor visits or to get prescription medications. Learn more about this benefit

Routine hearing exam and $3600 allowance toward brand-name hearing aids or UnitedHealthcare Hearing's brand Relate™. Learn more about this benefit

Lab services

$0 copay for all lab services

Meal Delivery

Up to 14 meals for 7 days, delivered one time per year after an inpatient hospital stay to maintain nutrition

No referrals required

Access to our large provider network with no referrals needed

Nurse Hotline

Speak to a registered nurse about your health-related questions or concerns anytime, day or night at no extra cost

Personal emergency response system (PERS)

Personal emergency response device that can get you help quickly, 24 hours a day at no extra cost

Prescription drug coverage

$0 copay on all covered generic and brand-name prescriptions including home delivery. Learn more about this benefit

Preventive care

$0 copay for preventive care, including annual physical and flu shot

Primary care visits

$0 copay for primary care visits to help you get the care you need to live healthier

Renew Active® Fitness Program

Renew Active® is a fitness program for body and mind to help stay active, at a gym or from home, at no cost

Renew by UnitedHealthcare

Renew by UnitedHealthcare® provides health and wellness resources that can help you live healthier at no additional cost

Rewards for staying active

Earn $10 per month in rewards for staying active by tracking your steps with Renew Rewards by UnitedHealthcare®

Routine foot care

Up to 4 foot care visits per year with $0 copay to help keep feet healthy with preventive care

Specialist Visits

$0 copay for specialist visits to get health care for a specific concern or part of the body

UnitedHealthcare® HouseCalls

Yearly check-ups at home to help stay up-to-date on your health between regular doctor's visits at no cost

UnitedHealthcare® Navigator

Get support from your Navigator, who is your go-to person to help you get the most out of your plan

Urgent & ER care coverage

Coverage for urgent and emergency care worldwide

Virtual medical or mental health visits

$0 copay virtual provider visits to discuss non-emergency medical concerns or general mental health conditions from home

Virtual medical visits

$0 copay virtual provider visits to discuss medical concerns, get a diagnosis and treatment for non-emergency conditions

UnitedHealthcare Dual Complete® (HMO-POS 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
75% $8.90
50% $17.90
25% $26.80

*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:

  • 1-800-Medicare of TTY users call 1-877-486-2048 (24 hours a day/7 days a week),
  • Your State Medicaid Office, or
  • The Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.

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 Benefits, Other downloadable resources.

Downloadable Resources (opens modal window)
View Available Resources (opens modal window)

Disclaimer information

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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

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.

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.