UHC Dual Complete TX-V010 (HMO-POS D-SNP)

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. · 2026 plan year

Plan ID H5322-038-000

HMOPOS★ 4 CMS StarsDual-Eligible SNP
MOOP (in-network)
$4,200
MOOP (combined)
—
Monthly premium
$0/mo
Part C $0 + Part D $0
Prescription drugs
Included

This plan in 2027

+1 more plan in TX

Plan information

Contract / Plan / Segment
H5322-038-000
Medical deductible
$0 — no deductible
Part D premium
$0/mo (part of the monthly premium above)
Part D deductible
$615/yr
Also owed
Your Medicare Part B premium, paid separately

More CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. plans in TX

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — Acute$175/day for days 1–6, $0 after
Inpatient Hospital — Additional Days (Acute)No charge
Inpatient Hospital — Psychiatric$175/day for days 1–6, $0 after
Worldwide Urgent Care CoverageNo charge

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual Sessions$0-$25
Mental Health — Group Sessions$15
Supplemental Health BenefitsSee plan details

Other

BenefitIn-network
Dental — ComprehensiveSee plan details
Diabetic SuppliesNo charge
Skilled Nursing Facility (SNF)$0/day for days 1–20, $218/day for days 21–100
Cardiac & Pulmonary RehabilitationSee plan details
Cardiac Rehabilitation — Additional SessionsNo charge
Intensive Cardiac Rehabilitation — Additional SessionsNo charge
Pulmonary Rehabilitation — Additional SessionsNo charge
Supervised Exercise Therapy (SET)No charge
Emergency Services$150
Urgently Needed Services$0-$65
Worldwide Emergency & Urgent CoverageSee plan details
Worldwide Emergency CoverageNo charge
Worldwide Emergency TransportationNo charge
Partial Hospitalization Program$55
Intensive Outpatient Program (IOP)$55
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Chiropractic Services$20
Occupational Therapy Services$20
Physician Specialist Services$0-$20
Podiatry Services$20
Other Health Care Professional Services$0-$20
Psychiatric ServicesSee plan details
Psychiatric Services — Individual Sessions$0-$25
Psychiatric Services — Group Sessions$15
Physical Therapy & Speech-Language Pathology$20
Additional Telehealth Services (Part B)No charge
Opioid Treatment Program ServicesNo charge
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & Tests$50
Laboratory ServicesNo charge
Radiological ServicesSee plan details
Diagnostic Radiology$0-$260
Therapeutic Radiology20% coinsurance
X-Ray Services$25
Outpatient Hospital Services$0-$175
Hospital Observation Services$175/day
Ambulatory Surgical Center (ASC)$0-$125
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual Sessions$0-$25
Substance Abuse — Group Sessions$15
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground Ambulance$275
Air Ambulance$275
Non-Emergency Transportation — Health FacilityNo charge
Durable Medical Equipment (DME)20% coinsurance
Prosthetics & OrthoticsSee plan details
Prosthetic Devices20% coinsurance
Medical Supplies20% coinsurance
Diabetic Supplies & ServicesSee plan details
Diabetic Therapeutic Shoes & Inserts20% coinsurance
Dialysis Services20% coinsurance
Over-the-Counter (OTC) ItemsNo charge
Medicare-Covered Preventive ServicesSee plan details
Annual Physical ExamNo charge
Fitness BenefitNo charge
Home & Bathroom Safety DevicesNo charge
Weight Management ProgramNo charge
In-Home Support ServicesNo charge
Caregiver Support ServicesNo charge
Kidney Disease Education ServicesNo charge
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)0%-20% coinsurance (max $35)
Dental — Medicare-Covered Services20% coinsurance
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Dental — X-RaysNo charge
Dental — Diagnostic ServicesNo charge
Dental — Prophylaxis (Cleaning)No charge
Dental — Fluoride TreatmentNo charge
Dental — Other Preventive ServicesNo charge
Dental — Restorative Services50% coinsurance
Dental — Endodontics (Root Canal)50% coinsurance
Dental — Periodontics (Gum Care)50% coinsurance
Dental — Removable Prosthodontics (Dentures)50% coinsurance
Dental — Maxillofacial Prosthetics50% coinsurance
Dental — Fixed Prosthodontics (Bridges)50% coinsurance
Dental — Oral & Maxillofacial Surgery50% coinsurance
Dental — Adjunctive General Services50% coinsurance
Vision — Eye ExamsNo charge
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — EyewearNo charge
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglass Lenses$0-$153
Vision — Eyeglass FramesNo charge
Hearing — ExamsNo charge
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)$199-$1,249
Hearing — OTC Hearing Aids$199-$829

Service area

  • TX: 136 counties

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