UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP)

H0271 - 020 - 0
4 out of 5 stars (4 / 5)

UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP) is a Medicare Advantage (Part C) Special Needs Plan by UnitedHealthcare.

This page features plan details for 2024 UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP) H0271 – 020 – 0 available in Select Counties in North Maine.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP) is offered in the following locations.

Plan Overview

UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP) offers the following coverage and cost-sharing.

Special Needs Plan Type:Dual-Eligible
Conditions Covered:
Insurer:UnitedHealthcare
Health Plan Deductible:$0.00
MOOP:$13,300 In and Out-of-network
$8,850 In-network
Drugs Covered:Yes
Please Note:
  • This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.
  • Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.

Ready to sign up for UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$174.70 $0.00 $0.00 $0.00 $174.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:$545.00
Initial Coverage Limit:$5,030.00
Catastrophic Coverage Limit:$8,000.00
Drug Benefit Type:Basic
Additional Gap Coverage:No
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

NOTE:  The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.

Initial Coverage Phase

After you pay your $545.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.

Tier Cost
All other tiers (Generic)25%
All other tiers (Brand-name)25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs.

Additional Benefits

UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

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

$13,300 In and Out-of-network
$8,850 In-network

Optional supplemental benefits

No

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

In-network No

Outpatient hospital coverage

In-network $0 copay (Authorization is required.) (Referral is not required.)
out-of-network 40% coinsurance per visit (Authorization is required.) (Referral is not required.)

Doctor visits

In-network Primary$0 copay (Not applicable.) (Not applicable.)
out-of-network Primary40% coinsurance per visit (Not applicable.) (Not applicable.)
In-network Specialist$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Specialist40% coinsurance per visit (Authorization is required.) (Referral is not required.)

Preventive care

In-network $0 copay (Authorization is not required.) (Referral is not required.)
out-of-network 0-40% coinsurance (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$0 copay (Not applicable.) (Not applicable.)
Urgent care$0 copay (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic tests and procedures40% coinsurance (Authorization is required.) (Referral is not required.)
In-network Lab services$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Lab services$0 copay (Authorization is required.) (Referral is not required.)
In-network Diagnostic radiology services (e.g., MRI)$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic radiology services (e.g., MRI)40% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient x-rays$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient x-rays40% coinsurance (Authorization is required.) (Referral is not required.)

Hearing

In-network Hearing exam$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Hearing exam40% coinsurance (Authorization is required.) (Referral is not required.)
Fitting/evaluationNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Hearing aids$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Hearing aids$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Preventive dental

In-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

In-network Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Diagnostic services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Periodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Periodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Extractions$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Extractions$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Vision

In-network Routine eye exam$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Routine eye exam40% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

In-network Occupational therapy visit$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Occupational therapy visit40% coinsurance (Authorization is required.) (Referral is not required.)
In-network Physical therapy and speech and language therapy visit$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Physical therapy and speech and language therapy visit40% coinsurance (Authorization is required.) (Referral is not required.)

Ground ambulance

In-network $0 copay (Not applicable.) (Not applicable.)
out-of-network 20% coinsurance (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

In-network Foot exams and treatment$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Foot exams and treatment40% coinsurance (Authorization is required.) (Referral is not required.)
In-network Routine foot care$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)$0 copay (Authorization is required.) (Not applicable.)
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen)40% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)$0 copay (Authorization is required.) (Not applicable.)
out-of-network Prosthetics (e.g., braces, artificial limbs)40% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Diabetes supplies$0 copay (Authorization is required.) (Not applicable.)
out-of-network Diabetes supplies40% coinsurance per item (Authorization is required.) (Not applicable.)

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

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy$0 copay (Authorization is required.) (Not applicable.)
out-of-network Chemotherapy0-40% coinsurance (Authorization is required.) (Not applicable.)
In-network Other Part B drugs$0 copay (Authorization is required.) (Not applicable.)
out-of-network Other Part B drugs0-40% coinsurance (Authorization is required.) (Not applicable.)
In-network Part B Insulin drugs$0 copay (Authorization is required.) (Not applicable.)
out-of-network Part B Insulin drugs0-40% coinsurance (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

In-network $0 copay (Authorization is required.) (Referral is not required.)
out-of-network 40% per stay (Authorization is required.) (Referral is not required.)

Mental health services

In-network Inpatient hospital – psychiatric$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Inpatient hospital – psychiatric40% per stay (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit with a psychiatrist$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient group therapy visit with a psychiatrist40% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit with a psychiatrist$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit with a psychiatrist40% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient group therapy visit40% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit40% coinsurance (Authorization is required.) (Referral is not required.)

Skilled Nursing Facility

In-network $0 copay (Authorization is required.) (Referral is not required.)
out-of-network 25% per stay (Authorization is required.) (Referral is not required.)

Ready to sign up for UHC Northern Light Health Dual Complete ME-S002 (PPO D-SNP) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

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