UHC Complete Care Support FG-5 (PPO C-SNP) H2001-135 • 2027 • Itasca County, MN
- Monthly Premium
- $19.60Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $7150.00In-network
- Part B Giveback
- −$2.00 reduction
- Prescription Coverage
- Basic, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Itasca County, MN
- Local Enrollment
- 108 beneficiaries in Itasca County
Introduction
UHC Complete Care Support FG-5 is a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by UnitedHealthcare. The plan uses a Preferred Provider Organization (PPO) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $19.60 monthly premium, $0.00 medical deductible, and $7150.00 in-network maximum out-of-pocket. CMS Plan ID H2001-135 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.
You must live in Itasca County, Minnesota to enroll in this plan. CMS reports 108 beneficiaries enrolled in this plan in Itasca County. For assistance with this plan, new members can call (800)555-5757 (TTY 711).
Eligibility
UHC Complete Care Support FG-5 is a Medicare C-SNP plan for individuals with specific chronic conditions.
- Special Needs Plan Type
- Chronic Condition Special Needs Plan (C-SNP)
- Medicare Requirement
- Must have Medicare Part A and Part B
- Special Needs Requirement
- This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes mellitus.
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Compare Similar Plans in Itasca County
No other PPO C-SNP plans are available in Itasca County, Minnesota using the same plan-type comparison criteria.
Plan Benefits
UHC Complete Care Support FG-5 has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H2001-135.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H2001-135-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $15 copay - Specialist
- In-network: $0-$50 copay
Out-of-network: $70 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: 40% coinsurance - Telehealth benefit
- Not covered
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
Out-of-network: 90% coinsurance - Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$285 copay
Out-of-network: $0-$385 copay - Lab services
- In-network: $0 copay
Out-of-network: $0 copay - Outpatient x-rays
- In-network: $25 copay
Out-of-network: $45 copay - Diagnostic tests and procedures
- In-network: $45 copay
Out-of-network: $65 copay
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0-$50 copay
- Inpatient hospital care
- In-network:
Tier 1
$550 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
40% per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
$250 per day for days 1-100
$0 per stay - Ground ambulance
- In-network: $350 copay
Out-of-network: $350 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $0-$15 copay
Out-of-network: $15 copay - Outpatient group therapy
- In-network: $15 copay
Out-of-network: $15 copay - Inpatient psychiatric hospital care
- In-network:
Tier 1
$550 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
40% per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $50 copay
Out-of-network: $70 copay - Occupational therapy
- In-network: $50 copay
Out-of-network: $70 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
Out-of-network: 50% coinsurance - Durable medical equipment
- In-network: 25% coinsurance
Out-of-network: 50% coinsurance - Prosthetics
- In-network: 25% coinsurance
Out-of-network: 50% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance
Dental Services
- 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
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: $70 copay - Contact lenses
- In-network: $0 copay
Out-of-network: 90% coinsurance - Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- In-network: $0 copay
Out-of-network: 90% coinsurance - Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
Out-of-network: $70 copay - Fitting/evaluation
- Not covered
- Prescription hearing aids
- In-network: $0 copay
Out-of-network: 90% coinsurance - OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- In-network: $0 copay
Out-of-network: 90% coinsurance
Certain preventive services are covered 100% by UHC Complete Care Support FG-5 as a Part B benefit.
Prescription Drug Coverage
UHC Complete Care Support FG-5 includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $19.60 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $19.60 |
| Low-Income Premium Subsidy: | $24.60 |
| Low-Income Premium Subsidy Paid by CMS: | $19.60 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before UnitedHealthcare starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, UHC Complete Care Support FG-5 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | 25% coinsurance |
| Generic drugs | 25% coinsurance | 25% coinsurance |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H2001)
CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for UnitedHealthcare
- Website
- UnitedHealthcare Plan Page
- Providers
- UnitedHealthcare Providers Page
- Formulary
- UnitedHealthcare Formulary Page
- Pharmacy
- UnitedHealthcare Pharmacy Page
- New Member Health Plan Help
- (800)555-5757
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (800)555-5757
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| UnitedHealthcare (official source) | http://UHC.com/Medicare | October 4, 2026 |
| CMS.gov | Chronic Condition Special Needs Plans (C-SNPs) | April 28, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | April 28, 2026 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | April 28, 2026 |
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