UHC Dual Complete VA-Y4 (PPO D-SNP)

Available to residents of Hampton City County, VA for 2027. Contract H0421, plan 001, segment 0.

2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.

Renewed for 2027. CMS carries this plan forward from 2026. Every VA plan’s 2026–2027 changes →

Plan details

Monthly premium (Part C + D)	$6.30
— medical (Part C) part	$0.00
— drug (Part D) part	$6.30?
Monthly premium with full Extra Help (LIS)	$0.00?
Part B premium reduction (giveback)	None
In-network out-of-pocket maximum	$9,850.00?
In- and out-of-network out-of-pocket maximum	$14,800.00
Drug deductible	$700.00
Drug out-of-pocket threshold	$2,400.00
Plan type	PPO D-SNP?
Special needs plan	Dual-eligible SNP
D-SNP integration status	Highly Integrated (HIDE)
Zero-dollar cost sharing D-SNP	Yes
Contract / plan	H0421-001-0
Offered by	UnitedHealthcare
Parent organization	UnitedHealth Group, Inc.
Pharmacy search	UHC.com/CommunityPlan
Member services	(888)834-3721TTY 711

CMS star ratings

Overall: 3 out of 5 stars for Overall
Health plan (Part C): 3 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 3 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H0421 shares this rating.

Plan health benefits

Service	In-network	Out-of-network?
Doctor visits
Primary care doctor	0%–20% coinsurance	30% coinsurance
Specialist	0%–20% coinsurance(authorization required)	30% coinsurance
Other health care professional	0%–20% coinsurance(authorization required)	30% coinsurance
Additional telehealth services	Not covered	—
Preventive care
Medicare-covered preventive services	$0 copay	0%–40% coinsurance
Annual physical exam	$0 copay	40% coinsurance
Kidney disease education	$0 copay	40% coinsurance
Glaucoma screening	$0 copay	40% coinsurance
Diabetes self-management training	$0 copay	40% coinsurance
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	20% coinsurance(authorization required)	40% coinsurance
Lab services	$0 copay(authorization required)	$0 copay
Diagnostic radiology (e.g. MRI, CT)	0%–20% coinsurance(authorization required)	40% coinsurance
Therapeutic radiology	20% coinsurance(authorization required)	20% coinsurance
Outpatient x-rays	20% coinsurance(authorization required)	40% coinsurance
Emergency and urgent care
Emergency room	$115 copay	—
Urgent care	$0–$40 copay	—
Worldwide emergency coverage	Not covered	—
Worldwide urgent care	Not covered	—
Worldwide emergency transportation	Not covered	—
Hospital care
Inpatient hospital stay	$1,655 per stay; $0 per day for days 91–999 (additional days)(authorization required)	$1,655 per stay
Outpatient hospital services	0%–20% coinsurance(authorization required)	40% coinsurance
Outpatient observation	20% coinsurance(authorization required)	40% coinsurance
Ambulatory surgical center	0%–20% coinsurance(authorization required)	40% coinsurance
Outpatient blood services	20% coinsurance(authorization required)	40% coinsurance
Skilled nursing and home health
Skilled nursing facility	Original Medicare cost-sharing(authorization required)	Original Medicare cost-sharing
Home health care	$0 copay(authorization required)	$0 copay
Kidney dialysis	20% coinsurance(authorization required)	20% coinsurance
Rehabilitation
Occupational therapy	20% coinsurance(authorization required)	30% coinsurance
Physical therapy and speech-language therapy	20% coinsurance(authorization required)	30% coinsurance
Cardiac rehabilitation	20% coinsurance(authorization required)	30% coinsurance
Pulmonary rehabilitation	20% coinsurance(authorization required)	30% coinsurance
Mental health and substance use
Inpatient psychiatric hospital stay	$1,655 per stay(authorization required)	$1,655 per stay
Outpatient mental health, individual session	0%–20% coinsurance(authorization required)	30% coinsurance
Outpatient mental health, group session	20% coinsurance(authorization required)	30% coinsurance
Psychiatrist, individual session	0%–20% coinsurance(authorization required)	30% coinsurance
Psychiatrist, group session	20% coinsurance(authorization required)	30% coinsurance
Partial hospitalization	$55 copay(authorization required)	30% coinsurance
Intensive outpatient program	$55 copay(authorization required)	30% coinsurance
Outpatient substance use, individual session	0%–20% coinsurance(authorization required)	30% coinsurance
Outpatient substance use, group session	20% coinsurance(authorization required)	30% coinsurance
Opioid treatment program	$0 copay(authorization required)	$0 copay
Ambulance and transportation
Ground ambulance	20% coinsurance(authorization required)	20% coinsurance
Air ambulance	20% coinsurance(authorization required)	20% coinsurance
Transportation to plan-approved locations	$0 copay(limits apply)	75% coinsurance
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	20% coinsurance(authorization required)	20% coinsurance
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)	20% coinsurance
Medical supplies	20% coinsurance(authorization required)	20% coinsurance
Diabetes supplies	$0 copay(authorization required)	20% coinsurance
Diabetic therapeutic shoes or inserts	20% coinsurance(authorization required)	20% coinsurance
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	20% coinsurance(authorization required)	30% coinsurance
Routine chiropractic care	Not covered	—
Acupuncture	Not covered	—
Foot exams and treatment (Medicare-covered)	20% coinsurance(authorization required)	30% coinsurance
Routine foot care	$0 copay(authorization required, limits apply)	30% coinsurance
Dental?
Medicare-covered dental services	20% coinsurance(authorization required)	40% coinsurance
Preventive dental plan limit	$2,500 plan limit every year	—
Oral exams	$0 copay(limits apply)	$0 copay
Cleanings	$0 copay(limits apply)	$0 copay
Fluoride treatment	$0 copay(limits apply)	$0 copay
Dental x-rays	$0 copay(limits apply)	$0 copay
Other diagnostic dental services	$0 copay(limits apply)	$0 copay
Other preventive dental services	$0 copay(limits apply)	$0 copay
Restorative services (fillings, crowns)	$0 copay(limits apply)	$0 copay
Endodontics (root canals)	$0 copay(limits apply)	$0 copay
Periodontics (gum disease)	$0 copay(limits apply)	$0 copay
Dentures and other removable prosthodontics	$0 copay(limits apply)	$0 copay
Maxillofacial prosthetics	$0 copay(limits apply)	$0 copay
Implants	Not covered	—
Bridges and other fixed prosthodontics	$0 copay(limits apply)	$0 copay
Oral and maxillofacial surgery	$0 copay(limits apply)	$0 copay
Orthodontics	Not covered	—
Adjunctive general services	$0 copay(limits apply)	$0 copay
Vision?
Eye exam (Medicare-covered)	$0 copay(authorization required)	30% coinsurance
Routine eye exam	$0 copay(authorization required, limits apply)	30% coinsurance
Eyewear after cataract surgery (Medicare-covered)	$0 copay(limits apply)	40% coinsurance
Eyewear plan limit	$300 plan limit every year	—
Contact lenses	$0 copay(limits apply)	90% coinsurance
Eyeglasses (frames and lenses)	$0 copay(limits apply)	90% coinsurance
Eyeglass lenses	Not covered	—
Eyeglass frames	Not covered	—
Eyewear upgrades	Not covered	—
Hearing?
Hearing exam (Medicare-covered)	20% coinsurance(authorization required)	30% coinsurance
Routine hearing exam	$0 copay(authorization required, limits apply)	30% coinsurance
Hearing aid fitting and evaluation	Not covered	—
Hearing aid plan limit	$2,200 plan limit every two years	—
Hearing aids (all types)	$0 copay(authorization required, limits apply)	90% coinsurance
Hearing aids, inner ear	Not covered	—
Hearing aids, outer ear	Not covered	—
Hearing aids, over the ear	Not covered	—
Medicare Part B drugs
Part B insulin	0%–20% coinsurance(authorization required)	20% coinsurance
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required)	20% coinsurance
Other Part B drugs	0%–20% coinsurance(authorization required)	20% coinsurance
Other extra benefits?
Over-the-counter (OTC) allowance	Covered (allowance not stated)	—
Meals after a hospital stay or for a chronic condition	Not covered	—
Fitness benefit	$0 copay	90% coinsurance
Health education	Not covered	—
Nutritional / dietary benefit	Not covered	—
Extra smoking and tobacco cessation counseling	Not covered	—
Enhanced disease management	Not covered	—
Telemonitoring	Not covered	—
Remote access technologies (web/phone, nurse line)	Not covered	—
Home and bathroom safety devices	$0 copay	90% coinsurance
Counseling services	Not covered	—
In-home safety assessment	Not covered	—
Personal emergency response system (PERS)	Not covered	—
Medical nutrition therapy	Not covered	—
Post-discharge in-home medication reconciliation	Not covered	—
Re-admission prevention	Not covered	—
Wigs for hair loss from chemotherapy	Not covered	—
Weight management programs	$0 copay	90% coinsurance
Alternative therapies	Not covered	—
Therapeutic massage	Not covered	—
Adult day health services	Not covered	—
Home-based palliative care	Not covered	—
In-home support services	$0 copay	90% coinsurance
Support for caregivers	$0 copay	90% coinsurance

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2027). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.

Star rating measures

Each CMS star measure for contract H0421, 2027 against 2026
Measure	2027	2026
Staying Healthy: Screenings, Tests and Vaccines
Breast Cancer Screening · C01	2 out of 5 stars for Breast Cancer Screening	too new
Colorectal Cancer Screening · C02	2 out of 5 stars for Colorectal Cancer Screening	too new
Annual Flu Vaccine · C03	3 out of 5 stars for Annual Flu Vaccine	too new
Managing Chronic (Long Term) Conditions
Special Needs Plan (SNP) Care Management · C07	2 out of 5 stars for Special Needs Plan (SNP) Care Management	too new
Care for Older Adults – Medication Review · C08	3 out of 5 stars for Care for Older Adults – Medication Review	too new
Care for Older Adults - Functional Status Assessment · C09	4 out of 5 stars for Care for Older Adults - Functional Status Assessment	new measure
Diabetes Care – Eye Exam · C11	3 out of 5 stars for Diabetes Care – Eye Exam	too new
Diabetes Care – Blood Sugar Controlled · C12	3 out of 5 stars for Diabetes Care – Blood Sugar Controlled	too new
Kidney Health Evaluation for Patients with Diabetes · C13	2 out of 5 stars for Kidney Health Evaluation for Patients with Diabetes	too new
Controlling High Blood Pressure · C14	2 out of 5 stars for Controlling High Blood Pressure	too new
Plan All-Cause Readmissions · C17	2 out of 5 stars for Plan All-Cause Readmissions	too new
Statin Therapy for Patients with Cardiovascular Disease · C18	2 out of 5 stars for Statin Therapy for Patients with Cardiovascular Disease	too new
Transitions of Care · C19	2 out of 5 stars for Transitions of Care	too new
Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions · C20	2 out of 5 stars for Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions	too new
Member Experience with Health Plan
Getting Needed Care · C21	3 out of 5 stars for Getting Needed Care	too new
Rating of Health Plan · C25	2 out of 5 stars for Rating of Health Plan	too new
Member Complaints and Changes in the Health Plan's Performance
Complaints about the Health Plan · C27	4 out of 5 stars for Complaints about the Health Plan	too new
Members Choosing to Leave the Plan · C28	2 out of 5 stars for Members Choosing to Leave the Plan	not enough data
Health Plan Customer Service
Plan Makes Timely Decisions about Appeals · C30	5 out of 5 stars for Plan Makes Timely Decisions about Appeals	not enough data
Reviewing Appeals Decisions · C31	5 out of 5 stars for Reviewing Appeals Decisions	not enough data
Call Center – Foreign Language Interpreter and TTY Availability · C32	5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability	5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability
DD1: Drug Plan Customer Service
Call Center – Foreign Language Interpreter and TTY Availability · D01	5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability	5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability
DD2: Member Complaints and Changes in the Drug Plan’s Performance
Complaints about the Drug Plan · D02	4 out of 5 stars for Complaints about the Drug Plan	too new
Members Choosing to Leave the Plan · D03	2 out of 5 stars for Members Choosing to Leave the Plan	not enough data
DD3: Member Experience with the Drug Plan
Rating of Drug Plan · D05	4 out of 5 stars for Rating of Drug Plan	too new
DD4: Drug Safety and Accuracy of Drug Pricing
MPF Price Accuracy · D07	5 out of 5 stars for MPF Price Accuracy	too new
Medication Adherence for Diabetes Medications · D08	2 out of 5 stars for Medication Adherence for Diabetes Medications	too new
Medication Adherence for Hypertension (RAS antagonists) · D09	3 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists)	too new
Medication Adherence for Cholesterol (Statins) · D10	3 out of 5 stars for Medication Adherence for Cholesterol (Statins)	too new
Statin Use in Persons with Diabetes (SUPD) · D11	2 out of 5 stars for Statin Use in Persons with Diabetes (SUPD)	too new
Concurrent Use of Opioids and Benzodiazepines (COB) · D12	3 out of 5 stars for Concurrent Use of Opioids and Benzodiazepines (COB)	new measure
Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) · D13	2 out of 5 stars for Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH)	new measure

Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H0421 shares it.

Benefits in plain text

UHC Dual Complete VA-Y4 (PPO D-SNP) (H0421-001-0) is a 2027 PPO D-SNP Medicare Advantage plan offered by UnitedHealthcare, available to residents of Hampton City County, VA.

The monthly premium is $6.30.

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.

Its in-network out-of-pocket maximum is $9,850.00.

The combined in- and out-of-network out-of-pocket maximum is $14,800.00.

The drug deductible is $700.00.

It is a special needs plan (Dual-eligible SNP).

CMS gives the plan's contract (H0421) an overall rating of 3 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.