UHC Dual Complete NY-Y001 (HMO-POS D-SNP)
Medicare
What is a dual special needs plan?
H3387-013 -000
Monthly premium: $0.00 *
* Your costs may be as low as $0, depending on your level of Medicaid eligibility.
Our plan is a Medicare Advantage HMO Plan (HMO stands for Health Maintenance Organization) with a Point-of-Service (POS) option approved by Medicare and run by a private company. "Point-of-Service" means you can use providers outside the plan's network for an additional cost. For those who have full Medicaid benefits. When enrolling in this plan, you must also apply for the Medicaid Advantage Plus (MAP) program with UHC: NY: FBDE, QMB PLUS.
Our plan is a plan for individuals who have Medicare and Medicaid coverage and need long term care. Enrollment in the program includes coverage for all Medicare and Medicaid services.
This plan is available in the following counties:
Albany, Bronx, Broome, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Dutchess, Erie, Essex, Franklin, Fulton, Genesee, Greene, Herkimer, Jefferson, Kings, Lewis, Livingston, Madison, Monroe, Nassau, New York, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Queens, Rensselaer, Richmond, Rockland, Schenectady, Seneca, St. Lawrence, Suffolk, Tioga, Ulster, Warren, Wayne, Westchester, Wyoming, and Yates.
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Check eligibility
If you can answer "yes" to the three questions below, there's a good chance you may qualify for this dual health plan.
Do you qualify for state Medicaid benefits?
- You must be eligible for Medicare and have full Medicaid coverage in one of the following categories: FBDE, QMB PLUS
Do you have Medicare Parts A and B?
You are eligible for Original Medicare (Parts A and B) if:
- You're at least 65 years old, or you're under 65 and qualify on the basis of disability or other special situation.
AND
- You're a U.S. citizen or a legal resident who has lived in the U.S. for at least five consecutive years.
Do you live in the Plan’s service area?
- A UnitedHealthcare representative can confirm if you live in the service area.
Are you 65 years or older but don’t qualify? Find Medicare Advantage, Medicare Supplement or Prescription Drug Plans at uhc.com/medicare
- UHC Dual Complete NY-Y001 (HMO-POS D-SNP)
1-844-812-5967 TTY: 711 8 a.m.-8 p.m. local time, 7 days a week
Find providers and coverage for this plan.
Search for doctors, hospitals, and specialists.
Search for providers, clinics and treatment centers.
Find medications covered by this plan.
Find a pharmacy near you.
Find a dentist near you.
Find a vision provider near you.
Benefits & features
No allowance limit for covered dental services like cleanings and crowns
$310 credit every month for OTC, plus healthy food and utilities for qualifying members
Free gym membership at core locations
$0 copay for primary care, hospital stays and specialist visits
$0 copay for Tier 1 prescriptions
Provider network
PCP-guided care plus access to our large provider network
Optum HouseCalls
Yearly in-home visit to help support your health
Behavioral Health (Mental Health/Substance Use Services)
UnitedHealthcare is here to assist you in all your healthcare needs. UHC has designated staff with sufficient knowledge to help insureds find participating behavioral health providers that treat the insured’s specific behavioral health condition. UHC also has trained professionals who are experienced in understanding mental health and substance use disorder and able to help you get treatment or give you information that will help you make decisions about your healthcare. You or your provider can call Optum Behavioral Health anytime for help by calling the customer service number listed on the back of your member ID card.
UnitedHealthcare provides coverage for both mental health and substance use services, which include:
- Inpatient mental health and substance use treatment services (including alcohol and substance use disorder)
- Most outpatient mental health treatment services (refer to member handbook for details)
- Most outpatient substance use treatment services (refer to member handbook for details)
Use the following list as the appointment standards for our limits on how long you may have to wait after your request for a behavioral health appointment:
- Initial appointment with an outpatient facility or clinic: 10 business days
- Initial appointment with a behavioral health care professional who is not employed by or contracted with an outpatient facility or clinic: 10 business days
- Follow-up visit after mental health/substance abuse emergency room (ER) or inpatient visit: 5 business days
- Non-urgent mental health or substance abuse visit: 5 business days
Note: Telehealth may be used to meet the appointment wait times, unless the insured specifically requests an in-person appointment.
Process to submit a behavioral health access complaint:
If you are unable to schedule a behavioral health appointment within the appointment wait times listed above, you, or your designee, may submit a behavioral health access complaint to UnitedHealthcare Community Plan by telephone, 1-866-547-0772 and in writing to: Member Complaints, Grievances and Appeals, UnitedHealthcare Community Plan of New York, P.O. Box 31364, Salt Lake City, UT,84131-0364 to resolve this issue.
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.
The fitness benefit and gym network varies by plan/area and participating locations may change. The fitness benefit includes a standard fitness membership at participating locations. Not all plans offer access to premium locations. Consult your doctor prior to beginning an exercise program or making changes to your lifestyle or health care routine.
Network size varies by local market and exclusions may apply.
Referrals may be needed to see network specialists.
Optum HouseCalls may not be available in all areas.
UHC Dual Complete NY-Y001 (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 |
*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 or 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 8 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 of Benefits, Other downloadable resources.
Learn more about dual special needs plans
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UHC Dual Complete NY-Y001 (HMO-POS D-SNP)