UnitedHealthcare® Medicare Advantage plans are offered by UnitedHealthcare Insurance Company and its affiliated companies, a Medicare Advantage organization with a Medicare contract. UnitedHealthcare Dual Complete™ (HMO SNP) plans are special needs plans available to all people meeting certain eligibility requirements, such as having both Medical Assistance from the state and Medicare.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Limitations, copayments, and coinsurance may apply. Benefits may vary by county and plan. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help that you may receive. For more information, contact Customer Service at 1.800.290.4009, TTY: 711, 7 days a week, between 8 a.m. and 8 p.m. local time. Or write us at Unison Plaza, Pittsburgh, PA  15221, or go to www.UHCDualComplete.com. This document is available in alternative formats. You must have both Medicare Parts A and B, and must reside in the service area of the plan. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Your ability to enroll in a special needs plan is not limited to certain times of the year.

For more information, contact Customer Service at 1.800.290.4009, TTY: 711, 7 days a week, between 8 a.m. and 8 p.m. local time. HMO members must use plan providers except in emergency or urgent care situations or for Out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor UnitedHealthcare® Medicare Advantage plans will be responsible for the costs. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227), TTY: 1-877-486-2048, 24 hours a day, 7 days a week; the Social Security Office at 1-800-772-1213, between 7 a.m. and 7 p.m., Monday through Friday, TTY: 1-800-325-0778; or your state Medicaid office. The Medicare Prescription Drug benefit is only available to members of the Medicare Advantage with Prescription Drug (MA-PD) plan. By enrolling in an MA-PD you will automatically be disenrolled from any existing Medicare Prescription Drug coverage. To receive the highest level of benefit you must use contracted network pharmacies to access your prescription drug benefit except in the case of emergency. The pharmacy network includes retail, mail order, long-term care, home infusion and I/T/U (Indian Health Service, Tribes or Urban Indian) pharmacy services. You may obtain your prescriptions from pharmacies outside the contracted network at a reduced benefit. Quantity limitations and restrictions may apply. For information about mail order, names and addresses of network pharmacies or for more information call 1.800.290.4009, or TTY 711, Monday through Friday, 8:00 a.m. to 8:00 p.m. local time. Or write us at at Unison Plaza, Pittsburgh, PA  15221, or go to www.UHCDualComplete.com. The plan’s contract with the Centers for Medicare & Medicaid Services is renewed annually. Availability of coverage beyond the end of the current contract year is not guaranteed.