2019 UnitedHealthcare Dual Complete RP (Regional PPO SNP) DS-R1548

UnitedHealthcare Dual Complete RP (Regional PPO SNP) By UnitedHealthcare

UnitedHealthcare Dual Complete RP (Regional PPO SNP) is a 2019 Medicare Advantage Special Needs Plan plan by UnitedHealthcare. This plan from UnitedHealthcare works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from UnitedHealthcare and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. UnitedHealthcare Dual Complete RP (Regional PPO SNP) DS-R1548 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.

2019 Medicare Special Needs Plan Details

Plan Name:
UnitedHealthcare Dual Complete RP (Regional PPO SNP)
Plan ID:
Special Needs Type: Dual-Eligible
Provider: UnitedHealthcare
Plan Year:2019
Plan Type: Regional PPO
Monthly Premium C+D: $26.30


The UnitedHealthcare Dual Complete RP (Regional PPO SNP) DS-R1548 is available to residents in Virginia, North Carolina, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. UnitedHealthcare Dual Complete RP (Regional PPO SNP) is a Regional PPO. A preferred provider organization (PPO) is a medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Part-C Premium

UnitedHealthcare plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

The UnitedHealthcare Dual Complete RP (Regional PPO SNP) plan has a monthly drug premium of $26.30 and a $415.00 drug deductible. This UnitedHealthcare plan offers a $26.30 Part D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by UnitedHealthcare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $26.30. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The UnitedHealthcare Dual Complete RP (Regional PPO SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.60 for 75% low income subsidy $13.10 for 50% and $19.70 for 25%.

Part C Premium: $0.00
Part D (Drug) Premium: $26.30
Part D Supplemental Premium $0.00
Total Part D Premium: $26.30
Drug Deductible: $415.00
Tiers with No Deductible: 0
Benchmark: below the regional benchmark
Type of Medicare Health Plan: Defined Standard Benefit
Drug Benefit Type: Basic
Full LIS Premium: $0.00
75% LIS Premium: $6.60
50% LIS Premium: $13.10
25% LIS Premium: $19.70
Initial Coverage Limit:$3820
Gap Coverage: No

Gap Coverage

In 2019 once you and your plan provider have spent $3,820 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for brand-name drugs and 37% on generic drugs unless your plan offers additional coverage. This UnitedHealthcare plan does not offer additional coverage through the gap.

Plan Services

Health plan deductible


Emergency care/Urgent care

Emergency $0 copay
Urgent care $0 copay

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures Out-of-Network 40%
Diagnostic tests and procedures In-Network $0 copay
Lab services Out-of-Network $0 copay
Lab services In-Network $0 copay
Diagnostic radiology services (e.g., MRI) Out-of-Network 40%
Diagnostic radiology services (e.g., MRI) In-Network $0 copay
Outpatient x-rays Out-of-Network 40%
Outpatient x-rays In-Network $0 copay


Hearing exam Out-of-Network 40%
Hearing exam In-Network $0 copay
Fitting/evaluation Not covered
Hearing aids Out-of-Network $0 copay
Hearing aids In-Network $0 copay

Preventive dental

Oral exam Out-of-Network $0 copay
Oral exam In-Network $0 copay
Cleaning Out-of-Network $0 copay
Cleaning In-Network $0 copay
Fluoride treatment Not covered
Dental x-ray(s) Out-of-Network $0 copay
Dental x-ray(s) In-Network $0 copay

Comprehensive dental

Non-routine services Out-of-Network $0 copay
Non-routine services In-Network $0
Diagnostic services Out-of-Network $0 copay
Diagnostic services In-Network $0
Restorative services Out-of-Network $0 copay
Restorative services In-Network $0
Endodontics Not covered
Periodontics Out-of-Network $0 copay
Periodontics In-Network $0
Extractions Out-of-Network $0 copay
Extractions In-Network $0
Prosthodontics, other oral/maxillofacial surgery, other services Out-of-Network $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services In-Network $0


Routine eye exam Out-of-Network 40%
Routine eye exam In-Network $0
Other Not covered
Contact lenses Out-of-Network $0 copay
Contact lenses In-Network $0 copay
Eyeglasses (frames and lenses) Not covered
Eyeglass frames Out-of-Network $0 copay
Eyeglass frames In-Network $0 copay
Eyeglass lenses Out-of-Network $0 copay
Eyeglass lenses In-Network $0 copay
Upgrades Not covered

Mental health services

Inpatient hospital - psychiatric Out-of-Network 40% per stay
Inpatient hospital - psychiatric In-Network $0 copay
Outpatient group therapy visit with a psychiatrist Out-of-Network 40%
Outpatient group therapy visit with a psychiatrist In-Network $0 copay
Outpatient individual therapy visit with a psychiatrist Out-of-Network 40%
Outpatient individual therapy visit with a psychiatrist In-Network $0 copay
Outpatient group therapy visit Out-of-Network 40%
Outpatient group therapy visit In-Network $0 copay
Outpatient individual therapy visit Out-of-Network 40%
Outpatient individual therapy visit In-Network $0 copay

Skilled Nursing Facility

Out-of-Network 40% per stay
In-Network $0 copay

Rehabilitation services

Occupational therapy visit Out-of-Network 40%
Occupational therapy visit In-Network $0 copay
Physical therapy and speech and language therapy visit Out-of-Network 40%
Physical therapy and speech and language therapy visit In-Network $0 copay

Ground ambulance

Out-of-Network 20%
In-Network $0 copay

Other health plan deductibles?

In-Network No


Out-of-Network 75%
In-Network $0 copay

Foot care (podiatry services)

Foot exams and treatment Out-of-Network 40%
Foot exams and treatment In-Network $0 copay
Routine foot care Out-of-Network 40%
Routine foot care In-Network $0

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 40% per item
Durable medical equipment (e.g., wheelchairs, oxygen) In-Network $0 copay
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 40% per item
Prosthetics (e.g., braces, artificial limbs) In-Network $0 copay
Diabetes supplies Out-of-Network 40% per item
Diabetes supplies In-Network $0 copay

Wellness programs (e.g., fitness, nursing hotline)


Medicare Part B drugs

Chemotherapy Out-of-Network 30%
Chemotherapy In-Network $0 copay
Other Part B drugs Out-of-Network 30%
Other Part B drugs In-Network $0 copay

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$10,000 In and Out-of-network
$6,700 In-network

Optional supplemental benefits


Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network No

Inpatient hospital coverage

Out-of-Network 40% per stay
In-Network $0 copay

Outpatient hospital coverage

Out-of-Network 40% per visit
In-Network $0 copay

Doctor visits

Primary Out-of-Network 40% per visit
Primary In-Network $0 copay
Specialist Out-of-Network 40% per visit
Specialist In-Network $0 copay

Preventive care

Out-of-Network 0-40%
In-Network $0 copay

Coverage Area for UnitedHealthcare Dual Complete RP (Regional PPO SNP)

State: Virginia
North Carolina
County:Accomack, Alamance, Albemarle, Alexander,
Alexandria City, Alleghany, Alleghany,
Amelia, Amherst, Anson,
Appomattox, Arlington, Ashe,
Augusta, Avery, Bath,
Beaufort, Bedford, Bertie,
Bladen, Bland, Botetourt,
Bristol City, Brunswick, Brunswick,
Buchanan, Buckingham, Buena Vista City,
Buncombe, Burke, Cabarrus,
Caldwell, Camden, Campbell,
Caroline, Carroll, Carteret,
Caswell, Catawba, Charles City,
Charlotte, Charlottesville City, Chatham,
Cherokee, Chesapeake City, Chesterfield,
Chowan, Clarke, Clay,
Cleveland, Colonial Heights City, Columbus,
Covington City, Craig, Craven,
Culpeper, Cumberland, Cumberland,
Currituck, Danville City, Dare,
Davidson, Davie, Dickenson,
Dinwiddie, Duplin, Durham,
Edgecombe, Emporia City, Essex,
Fairfax, Fairfax City, Falls Church City,
Fauquier, Floyd, Fluvanna,
Forsyth, Franklin, Franklin,
Franklin City, Frederick, Fredericksburg City,
Galax City, Gaston, Gates,
Giles, Gloucester, Goochland,
Graham, Granville, Grayson,
Greene, Greene, Greensville,
Guilford, Halifax, Halifax,
Hampton City, Hanover, Harnett,
Harrisonburg City, Haywood, Henderson,
Henrico, Henry, Hertford,
Highland, Hoke, Hopewell City,
Hyde, Iredell, Isle of Wight,
Jackson, James City, Johnston,
Jones, King and Queen, King George,
King William, Lancaster, Lee,
Lee, Lenoir, Lexington City,
Lincoln, Loudoun, Louisa,
Lunenburg, Lynchburg City, Macon,
Madison, Madison, Manassas City,
Manassas Park City, Martin, Martinsville City,
Mathews, McDowell, Mecklenburg,
Mecklenburg, Middlesex, Mitchell,
Montgomery, Montgomery, Moore,
Nash, Nelson, New Hanover,
New Kent, Newport News City, Norfolk City,
Northampton, Northampton, Northumberland,
Norton City, Nottoway, Onslow,
Orange, Orange, Page,
Pamlico, Pasquotank, Patrick,
Pender, Perquimans, Person,
Petersburg City, Pitt, Pittsylvania,
Polk, Poquoson City, Portsmouth City,
Powhatan, Prince Edward, Prince George,
Prince William, Pulaski, Radford City,
Randolph, Rappahannock, Richmond,
Richmond, Richmond City, Roanoke,
Roanoke City, Robeson, Rockbridge,
Rockingham, Rockingham, Rowan,
Russell, Rutherford, Salem City,
Sampson, Scotland, Scott,
Shenandoah, Smyth, Southampton,
Spotsylvania, Stafford, Stanly,
Staunton City, Stokes, Suffolk City,
Surry, Surry, Sussex,
Swain, Tazewell, Transylvania,
Tyrrell, Union, Vance,
Virginia Beach City, Wake, Warren,
Warren, Washington, Washington,
Watauga, Wayne, Waynesboro City,
Westmoreland, Wilkes, Williamsburg City,
Wilson, Winchester City, Wise,
Wythe, Yadkin, Yancey,

Source: CMS.

Plans as of September 2, 2018.

Star Rating as of October 10, 2018.

Notes: Data are subject to change. All contracts for 2019 have not been finalized. For 2019, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2019 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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