State-level Medicaid, D-SNP Disclaimer:

The values shown in-network represent a range based upon the amount of the Medicare Parts A and B plan cost sharing covered by the state. Depending on your Medicaid eligibility, your Medicaid program may have cost sharing. For complete information, and for costs for those without Medicare Parts A and B plan cost sharing covered by the state, and applicable Medicaid cost sharing, please refer to your Summary of Benefits or Evidence of Coverage. Limitations, exclusions, and restrictions may apply.

Some of the benefits on a Dual Special Needs plan may also be available from the state Medicaid program or a managed Medicaid plan.

UHC Dual Complete AZ-S001 (HMO-POS D-SNP) and UHC Dual Complete AZ-Y001 (HMO-POS D-SNP) plans

Contract services are funded under contract with the State of Arizona.

UHC Dual Choice DC-Y001 (HMO D-SNP), UHC Dual Choice DC-Y2 (PPO D-SNP), and UHC Dual Choice DC-Y2 (PPO D-SNP) 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 District Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare and District Medicaid.

UHC Dual Choice DC-Y001 (HMO D-SNP) is insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the District Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare and District Medicaid.

UHC Dual Choice DC-Y2 (PPO D-SNP) is insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the District Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare and District Medicaid.

UHC Dual Choice DC-Q001 (PPO D-SNP) is insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the District Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare and District Medicaid.

UHC Senior Care Options MA-Y001 (HMO D-SNP) and UHC Senior Care Options NHC MA-Y002 plans

UHC Senior Care Options is a Dual Special Needs Plan (D-SNP) with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health insurance, except Medicare.

UHC One Care MA-Y3 (HMO D-SNP) and UHC One Care MA-Y4 (HMO D-SNP) plans

UHC One Care is a Dual Special Needs Plan (D-SNP) that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone age 21 - 64 who qualifies for MassHealth Standard or CommonHealth and Original Medicare and does not have any other comprehensive health insurance, except Medicare.

UHC Dual Complete MI-S002 (HMO-POS D-SNP), UHC Dual Advantage MI-Y001 (HMO-POS D-SNP), and UHC Dual Complete MI-Y001 (HMO D-SNP) plans

UHC Dual Complete plans (HMO and HMO-POS) have a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare.

UHC Dual Complete MI-Y1 (HMO D-SNP) plan

UHC Dual Complete MI-Y1 (HMO D-SNP) is a Highly Integrated Dual Eligible Special Needs Plan 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.

UHC Dual Complete NJ-Y001 (HMO D-SNP) is a Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP) with a Medicare contract and a contract with the New Jersey Medicaid program. Enrollment in UHC Dual Complete NJ-Y001 (HMO D-SNP) depends on contract renewal. This plan is available to anyone who has both Medicare and full New Jersey Medicaid benefits.

When joining this plan you must use in-network providers, DME (Durable Medical Equipment) suppliers, and pharmacies. You will be enrolled automatically into Medicaid (NJ FamilyCare) coverage under our plan, and disenrolled from any Medicaid (NJ FamilyCare) plan you are currently enrolled in. All of your Medicaid-covered services, items, and medications will then be covered under our plan, and you must get them from in-network providers. You will be enrolled automatically into Part D coverage under our plan, and you will be automatically disenrolled from any other Medicare Part D or creditable coverage plan in which you are currently enrolled. You must understand and follow our plan’s rules on referrals.

UHC Dual Complete NM-Y1 (PPO D-SNP) and UHC Dual Complete NM-Q1 (PPO D-SNP) plans

UnitedHealthcare Community Plan of New Mexico is a product of UnitedHealthcare Insurance Company. Such services are funded in part with the State of New Mexico. We do not discriminate based on race, color, national origin, age, disability or sex (including gender identity and sexual orientation).

UHC Dual Complete TN-Y001 (HMO-POS D-SNP) and UHC Dual Complete TN-Y2 (HMO-POS D-SNP) plans

Notice: TennCare is not responsible for payment for these benefits, except for appropriate cost sharing amounts. TennCare is not responsible for guaranteeing the availability or quality of these benefits. Any additional Medicare benefit mentioned in this communication above Original Medicare is applicable to the Medicare benefit only and does not indicate increased Medicaid benefits.

UHC Dual Complete TX-Y1 (HMO-POS D-SNP) is an Integrated FIDE Dual Special Needs health plan that contracts with both Medicare and STAR+PLUS Medicaid to provide benefits of both programs to enrollees. Continued enrollment depends on contract renewal with both Medicare and Medicaid.

UHC Dual Complete TX-Y4 (HMO-POS D-SNP) is a Highly Integrated Dual Eligible Special Needs health plan that contracts with both Medicare and STAR+PLUS Medicaid to provide benefits of both programs to enrollees. Continued enrollment depends on contract renewal with both Medicare and Medicaid.

UHC Dual Complete TX-Y3 (HMO-POS D-SNP) is a Highly Integrated Dual Eligible Special Needs health plan that contracts with both Medicare and STAR+PLUS Medicaid to provide benefits of both programs to enrollees. Continued enrollment depends on contract renewal with both Medicare and Medicaid.