UHC PathWays Dual Care IN-S3 (PPO D-SNP)
H2385-004 • 2026 • Jasper County, IN
UHC PathWays Dual Care IN-S3 (PPO D-SNP) H2385-004 • 2026 • Jasper County, IN
CMS Plan ID H2385-004 identifies the Medicare Dual-Eligible plan UHC PathWays Dual Care IN-S3, offered by UnitedHealthcare for the 2026 plan year. This Special Needs Plan (SNP) is designed for individuals who meet specific eligibility requirements.
UHC PathWays Dual Care IN-S3 Overview
Plan Overview for H2385-004-0 | |
|---|---|
| CMS Plan ID: | H2385-004-0 |
| Plan Type: | PPO D-SNP |
| Plan Year: | 2026 |
| Monthly Premium: | $38.40 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $9250.00 (In-Network) |
| Part B Give Back: | −$1.10 reduction |
| Prescription Drug Coverage: | Enhanced, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Jasper County, IN |
| Enrollment (Nationwide) | 10,299 beneficiaries |
| Enrollment (CMS – Local) | 18 beneficiaries in Jasper County |
| Provided By: | UnitedHealthcare |
Plan Overview and Eligibility
UHC PathWays Dual Care IN-S3 is a Medicare D-SNP plan for dual-eligible beneficiaries (Medicare and Medicaid).
- You must have Medicare Part A and Part B, live in one of the plan's specific service areas, and qualify for Medicaid to enroll.
- It includes Medicare Part D prescription drug coverage. The annual Part D deductible is $615.00.
- Benefits and cost-sharing may be coordinated with Medicaid coverage.
- Extra Help may provide additional assistance with prescription drug costs.
UHC PathWays Dual Care IN-S3 uses a Preferred Provider Organization (PPO) network for delivery of care. As a PPO member, you can receive services from both in-network and out-of-network providers, typically at a lower cost when using the plan’s network. Referrals are not usually required to see specialists. Emergency care and out-of-area dialysis are covered.
Covered Services and Cost Structure
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $0 copay |
| Specialist: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay | Out-of-network: 75% coinsurance |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $0 copay | Out-of-network: $0 copay |
| Lab services: | In-network: $0 copay | Out-of-network: $0 copay |
| Outpatient x-rays: | In-network: $0 copay | Out-of-network: $0 copay |
| Diagnostic tests and procedures: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $0 copay |
| Worldwide emergency care: | $0 copay |
| Urgent care: | $0 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $0 per stay | Out-of-network: | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $209.5 per day for days 21-100 | Out-of-network: | $0 per day for days 1-20 | $0 per day for days 21-100 |
| Ground ambulance: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $0 copay | Out-of-network: $0 copay |
| Outpatient group therapy: | In-network: $0 copay | Out-of-network: $0 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $0 per stay | Out-of-network: | $0 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $0 copay | Out-of-network: $0 copay |
| Occupational therapy: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay | Out-of-network: $0 copay |
| Durable medical equipment: | In-network: $0 copay | Out-of-network: $0 copay |
| Prosthetics: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: $0 copay | Out-of-network: $0 copay |
| Other Part B drugs (Medicare-covered): | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Dental x-rays: | In-network: $0 copay | Out-of-network: $0 copay |
| Cleaning: | In-network: $0 copay | Out-of-network: $0 copay |
| Periodontics: | In-network: $0 copay | Out-of-network: $0 copay |
| Endodontics: | In-network: $0 copay | Out-of-network: $0 copay |
| Restorative services: | In-network: $0 copay | Out-of-network: $0 copay |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: 30% coinsurance |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglasses (frames & lenses): | Not covered |
| Upgrades: | Not covered |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: 30% coinsurance |
| Fitting/evaluation: | Not covered |
| Prescription hearing aids: | In-network: $0 copay | Out-of-network: $0 copay |
| OTC hearing aids: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | In-network: $0 copay | Out-of-network: 75% coinsurance |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | In-network: $0 copay | Out-of-network: $0 copay |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $38.40 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $38.40 |
| Low Income Premium Subsidy: | $38.44 |
| Low Income Premium Subsidy CMS Pays: | $38.40 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Drug Plan Deductible
The prescription drug annual deductible with this plan is $615.00. This is the amount you must pay at the pharmacy before UnitedHealthcare begins paying its share.
Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and drug plan deductible, UHC PathWays Dual Care IN-S3 has costs that you must pay out-of-pocket when you pick up your prescriptions. The following table details those costs by formulary tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | 25% coinsurance | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
Plan Star Ratings
Medicare evaluates plan quality using a star rating system developed by the Centers for Medicare & Medicaid Services (CMS). Ratings are based on measures such as health outcomes, member experience, and customer service, and are reported on a 1 to 5 star scale, with higher ratings indicating stronger overall performance.
CMS Star Ratings for Plan H2385-004-0 – 2026
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | Plan too new to be measured |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Contact Information for UnitedHealthcare
| Contact Type | Details |
|---|---|
| Website: | UnitedHealthcare Plan Page |
| New Members: | 1-888-834-3721 |
| Existing Members: | 1-800-832-4643 |
| Plan Address: | P.O. Box 30769 | Salt Lake City, UT 84130 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation.
- UnitedHealthcare (official source), http://UHC.com/Medicare — Last accessed April 30, 2026
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)" — Last accessed April 28, 2026
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed April 28, 2026
- Medicare.gov, "Joining a plan" — Last accessed April 28, 2026
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