UHC Dual Advantage WI-V1 (HMO-POS D-SNP) H3794-004 • 2027 • Forest County, WI
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $5400.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $145.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Forest County, WI
- Local Enrollment
- 0 beneficiaries in Forest County
Introduction
UHC Dual Advantage WI-V1 is a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by UnitedHealthcare. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $0.00 monthly premium, $0.00 medical deductible, and $5400.00 in-network maximum out-of-pocket. CMS Plan ID H3794-004 identifies this plan. The 2027 Part D prescription drug deductible is $145.00.
You must live in Forest County, Wisconsin to enroll in this plan. CMS reports 0 beneficiaries enrolled in this plan in Forest County. For assistance with this plan, new members can call (888)834-3721 (TTY 711).
Eligibility
UHC Dual Advantage WI-V1 is a Dual Eligible Special Needs Plan (D-SNP) designed for individuals enrolled in both Medicare and Medicaid.
- Special Needs Plan Type
- Dual-Eligible Special Needs Plan (D-SNP)
- Medicare Requirement
- Medicare Part A and Part B
- Special Needs Requirement
- Must qualify for Medicaid
- 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 Forest County
Compare this plan with the two most-enrolled HMO-POS D-SNP plans available in Forest County, Wisconsin. Enrollment is based on CMS local enrollment data.
| Plan Detail | UHC Dual Advantage WI-V1 | UHC Dual Complete WI-Q1 | UHC Dual Complete WI-S1 |
|---|---|---|---|
| CMS Plan ID | H3794-004-0 |
H3794-002-0 |
H3794-011-2 |
| Local Enrollment | 0 | 109 | 0 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $5,400.00 | $9,850.00 | $9,850.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $0 or $0-$50 copay | $0 copay | $0 copay |
| Part D Deductible | $145.00 | $75.00 | $700.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
UHC Dual Advantage WI-V1 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 H3794-004.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H3794-004-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $0 or $0-$50 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- 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
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0 or $0-$320 copay
- Lab services
- In-network: $0 copay
- Outpatient x-rays
- In-network: $0 or $30 copay
- Diagnostic tests and procedures
- In-network: $0 or $45 copay
Emergency and Urgent Care Services
- Emergency room care
- $0 or $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0 or $0-$50 copay
- Inpatient hospital care
- In-network:
Tier 1
$0 or $550 per day for days 1-5
$0 per day for days 6-90
$0 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$0 or $221 per day for days 21-100 - Ground ambulance
- In-network: $0 or $220 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $0 or $0-$25 copay
- Outpatient group therapy
- In-network: $0 or $15 copay
- Inpatient psychiatric hospital care
- In-network:
Tier 1
$0 or $550 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $0 or $50 copay
- Occupational therapy
- In-network: $0 or $50 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 0% or 20% coinsurance
- Prosthetics
- In-network: 0% or 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0% or 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0% or 0%-20% 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
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance - Endodontics
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance - Restorative services
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- Not covered
- Prescription hearing aids
- In-network: $0 copay
- 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
- In-network: $0 copay
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- In-network: $0 copay
Certain preventive services are covered 100% by UHC Dual Advantage WI-V1 as a Part B benefit.
Prescription Drug Coverage
UHC Dual Advantage WI-V1 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: | ($28.20) |
| Supplemental Part D Premium: | $28.20 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $6.27 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $145.00 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 Dual Advantage WI-V1 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | $0.00 copay |
| Generic | $0.00 copay | 25% coinsurance |
| Preferred Brand | 25% coinsurance | 25% coinsurance |
| Non-Preferred Drug | 25% coinsurance | 25% coinsurance |
| Specialty Tier | 31% coinsurance | 25% coinsurance |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H3794)
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
- (888)834-3721
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (888)834-3721
- 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/CommunityPlan | October 4, 2026 |
| CMS.gov | Dual Eligible Special Needs Plans (D-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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