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2024 UHC Dual Complete MN-Y001 (HMO D-SNP)
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Medicare
What is a dual special needs plan?
H7778-001 -000
Monthly premium: $0.00 *
* Your costs may be as low as $0, depending on your level of Medical Assistance (Medicaid) eligibility.
SNBC (H7778-001-000): Minnesota Special Needs BasicCare (SNBC): Medicare & Medical Assistance (Medicaid)
Our plan is a Medicare Advantage HMO Plan (HMO stands for Health Maintenance Organization).
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Check eligibility (opens modal window)
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 have full Medicaid coverage in one of the following categories: QMB PLUS <65, SLMB PLUS <65 , FBDE <65
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
1-844-812-5967 TTY: 711 or use your preferred relay service 8:00 am to 8:00 pm local time, 7 days a week
Find providers and coverage for this plan.
Search for doctors, hospitals, and specialists.
Find medications covered by this plan.
Find a dentist near you.
Find a pharmacy near you.
Benefits & features
Food, OTC and Utilities
$225 credit every month to pay for healthy food, OTC products and utility bills Learn more about this benefit
Home support services
$150 credit every quarter for extra support at home to help with housekeeping, yard care, pest control and more
Prescription drug coverage
$0 copay for generic and brand-name prescriptions including Optum Home Delivery Pharmacy Learn more about this benefit
Routine transportation
$0 copay, the plan covers unlimited trips for medically necessary appointments and to pharmacies. In addition the plan covers 48 one-way trips to or from approved locations, such as gyms, community centers and places of worship
Routine hearing benefit
$0 copay for a routine hearing exam to help maintain and improve hearing health Learn more about this benefit
Meal Delivery
28 home-delivered meals for 14 days after every inpatient hospital stay
Nurse Hotline
Talk to a registered nurse about your health-related questions or concerns anytime, day or night at no cost
Personal emergency response system (PERS)
Wearable emergency device to get help 24 hours a day
Preventive care
$0 copay for preventive care, including an annual physical, flu shot, screenings and more
Primary care visits
$0 copay for primary care visits to help you get the care you need
Renew Active® Fitness Program
Stay active with a free gym membership through Renew Active®
Routine foot care
6 routine foot care visits for a $0 copay each visit for nail trims and other covered preventive care treatments
UnitedHealthcare® HouseCalls
Yearly in-home visit with a health care practitioner to help stay on top of your health between regular doctor visits
Virtual visits
$0 copay for virtual visits to talk about medical and mental health concerns from home
Extra help with costs: LIS premium summary table
UHC Dual Complete MN-Y001 (HMO 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 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 of Benefits, Other downloadable resources.
Annual Notice of Changes
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English (Opens in new window)
PDF 491.25KB - Last Updated: 02/14/2024
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Español (Spanish) (Se abre en una ventana nueva)
PDF 391.91KB - Last Updated: 04/09/2024
Enrollment Application
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English (Opens in new window)
PDF 408.46KB - Last Updated: 09/15/2023
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Español (Spanish) (Se abre en una ventana nueva)
PDF 493.80KB - Last Updated: 09/15/2023
Enrollment Kit
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English (Opens in new window)
PDF 5.06MB - Last Updated: 03/08/2024
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Español (Spanish) (Se abre en una ventana nueva)
PDF 5.05MB - Last Updated: 03/08/2024
Evidence of Coverage
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English (Opens in new window)
PDF 2.93MB - Last Updated: 07/17/2024
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Español (Spanish) (Se abre en una ventana nueva)
PDF 2.50MB - Last Updated: 08/12/2024
Formularies
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English (Opens in new window)
PDF 1.42MB - Last Updated: 10/01/2024
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Prior Authorization Criteria - English (Opens in new window)
PDF 1.66MB - Last Updated: 10/01/2024
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Step Therapy Criteria - English (Opens in new window)
PDF 56.36KB - Last Updated: 10/01/2024
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Español (Spanish) (Se abre en una ventana nueva)
PDF 2.80MB - Last Updated: 10/01/2024
Medicare Plan Star Ratings
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English (Opens in new window)
PDF 498.69KB - Last Updated: 10/23/2023
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Español (Spanish) (Se abre en una ventana nueva)
PDF 357.29KB - Last Updated: 10/23/2023
Provider Directories
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English (Opens in new window)
PDF 49.78MB - Last Updated: 10/07/2024
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Español (Spanish) (Se abre en una ventana nueva)
PDF 51.27MB - Last Updated: 10/07/2024
Summary of Benefits
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English (Opens in new window)
PDF 620.91KB - Last Updated: 08/09/2024
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Español (Spanish) (Se abre en una ventana nueva)
PDF 420.88KB - Last Updated: 08/09/2024
Vendor Information
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English (Opens in new window)
PDF 31.05KB - Last Updated: 09/22/2023
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Español (Spanish) (Se abre en una ventana nueva)
PDF 32.51KB - Last Updated: 09/22/2023
For Coverage Determinations
Mail: OptumRx Prior Authorization Department
P.O. Box 25183
Santa Ana, CA 92799
Fax: 1-844-403-1028
For Appeals
Mail: Medicare Part D Appeals and Grievance Department
PO Box 6106, M/S CA 124-0197
Cypress, CA 90630-9948
Fax: 1-866-308-6294
To inquire about the status of an appeal, contact UnitedHealthcare.
UnitedHealthcare Coverage Determination Part C
P. O. Box 29675
Hot Springs, AR 71903-9675
Call: 1-888-867-5511 TTY 711
Available 8 a.m. to 8 p.m. local time, 7 days a week
Fax/Expedited Fax: 1-501-262-7070
An appeal may be filed in writing directly to us.
UnitedHealthcare Coverage Determination Part D
P. O. Box 29675
Hot Springs, AR 71903-9675
Call: 1-888-867-5511 TTY 711
Available 8 a.m. to 8 p.m. local time, 7 days a week
Fax/Expedited Fax: 1-501-262-7070
Where can an Appeal be filed?
An appeal may be filed either in writing or verbally. See the contact information below:
- Medical/Part B appeals
UnitedHealthcare Complaint and Appeals Department
P. O. Box 6106
MS CA 124-0187
Cypress, CA 90630-0023
Fax:
Standard – 1-888-517-7113
Expedited - 1-866-373-1081
Or
Call: 1-888-867-5511
Available 8 a.m. to 8 p.m. local time, 7 days a week.
- Part D appeals
UnitedHealthcare Appeals and Grievances Department, Part D
P. O. Box 6106
MS CA 124-0197
Cypress, CA 90630-0023
Fax:
Standard – 1-866-308-6294
Expedited – 1-866-308-6296
Call:
Standard – 1-844-368-5888
Expedited – 1-855-409-7041
Available 8 a.m. to 8 p.m. local time, 7 days a week.
For the full Coverage Determination, Appeals and Grievance process, click here.
You can also file a complaint with Medicare using the Medicare Complaint Form.
Member resources
Flu shots
Flu Shots
Influenza is a serious illness that can be easily prevented by a simple shot.
- The best time to get a flu shot is before flu season starts. Talk to your doctor about what is right for you. You may want to write down when you get your shot, and plan to get it at the same time each year.
- When you get your flu shot, it is covered by the terms of your plan. For help scheduling an appointment, call the toll-free number on the back of your member ID card. Health coaches are available daily from 8 a.m. – 8 p.m. to help you.
Don't have time to see the doctor for a flu shot? Click here for list of locations where you can get a flu shot.
Knowing where to get care
Knowing where to get care. That's what matters.
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English (Opens in new window)
PDF 232.10KB - Last Updated: 07/18/2024
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Español (Spanish) (Se abre en una ventana nueva)
PDF 233.91KB - Last Updated: 07/18/2024
Learn more about dual special needs plans
Learn more
UHC Dual Complete MN-Y001 (HMO D-SNP)