The H2228-074 plan is a UnitedHealthcare Dual Complete Medicare Advantage plan for people who qualify for both Medicare and Medicaid. It sits under CMS contract H2228, held by UnitedHealthcare Insurance Company, and is one of several dual eligible special needs plans (D-SNPs) the insurer offers around the country.1CMS.gov. Approved MA Organizations for Default Enrollment Because it’s a D-SNP, it’s built specifically for “dual eligible” beneficiaries and coordinates benefits between Medicare and Medicaid to keep out-of-pocket costs down.
Who Can Enroll
Eligibility for H2228-074 requires enrollment in both Medicare (Parts A and B) and your state’s Medicaid program. The H2228 contract is approved by CMS for default enrollment, which means Medicaid managed care enrollees can be moved into an affiliated D-SNP without a separate application.1CMS.gov. Approved MA Organizations for Default Enrollment
Whether the plan runs as an HMO or a local PPO depends on the service area. Across the 2026 Medicare Advantage market, about 61% of individual enrollees are in HMO-type plans and about 38% are in local PPOs.2KFF. Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization The plan type matters because it determines whether you need referrals and how out-of-network care is handled. The specifics for your version of H2228-074 are in the Evidence of Coverage at myAARPMedicare.com.
One boundary worth naming: UnitedHealthcare reduced its Medicare Advantage footprint for 2026, offering plans in one fewer state and 109 fewer counties than in 2025.3Healthcare Dive. Medicare Advantage Plans 2026 If you’re new to the plan, confirm it’s still offered in your county before assuming continued coverage.
What the Plan Covers in 2026
Like all Medicare Advantage plans, H2228-074 must cover everything Original Medicare covers. As a D-SNP under the Dual Complete brand, it also carries benefits Original Medicare doesn’t.
On the drug side, UnitedHealthcare kept $0 copays for Tier 1 prescriptions across all D-SNP members for 2026, and roughly a quarter of D-SNP members pay $0 for every covered prescription.4UnitedHealth Group. UHC 2026 Medicare Advantage Plans Deliver Value, Access, Consumer Choice Preventive care, primary care visits, and lab work are also available at $0 copay across UnitedHealthcare’s 2026 MA plans.
Supplemental benefits commonly included in AARP-branded UnitedHealthcare MA plans cover:
- Preventive dental at $0 copay for exams, cleanings, X-rays, and fluoride treatments, with optional comprehensive dental available as a rider.
- Routine eye exams at $0 copay plus an annual allowance for frames or contacts.
- Up to two hearing aids per year.
- The Renew Active fitness program, which includes a gym membership and online classes at no cost.
- Virtual medical and mental health visits at $0 copay.
- Home-delivered meals after an inpatient hospital or skilled nursing stay.
- A quarterly over-the-counter allowance for covered health products.
For 2026, UnitedHealthcare said it expanded flexibility on the D-SNP over-the-counter, healthy food, and utility credits.4UnitedHealth Group. UHC 2026 Medicare Advantage Plans Deliver Value, Access, Consumer Choice At the same time, industry reporting noted that UnitedHealthcare reduced OTC allowances for special needs plans compared with prior years.3Healthcare Dive. Medicare Advantage Plans 2026 Check your Summary of Benefits for the current dollar amount tied to your plan.
New Rules That Take Effect in 2026
Three changes matter most for H2228-074 members this year.
Chronic Condition Verification for Food and Utility Benefits
As of January 1, 2026, both new and existing D-SNP and C-SNP members must have a qualifying chronic condition confirmed by a provider before using benefits that cover healthy food or utilities.5UHCProvider.com. MA Plan Updates 2026 If you’ve been using those credits, get the condition documented with your provider so the benefit isn’t interrupted.
Referrals for HMO and POS Members
Also starting January 1, 2026, members in HMO and Point of Service plans generally need a referral from their primary care provider before seeing specialists in office, outpatient, or home settings, and the referral has to be submitted to UnitedHealthcare before the visit.5UHCProvider.com. MA Plan Updates 2026 The rule applies even when you’re traveling and using the national network. PPO members generally do not need referrals to see specialists.6Medicare Interactive. PPO Costs and Coverage
Fewer Prior Authorizations, but Not for Everything
UnitedHealthcare began removing prior authorization requirements for about 30% of previously affected services as of April 2026. The reductions cover select outpatient surgeries, diagnostic tests such as echocardiograms, certain outpatient therapies, and chiropractic care.7UnitedHealthcare. Streamlining the Prior Authorization Process
Prior authorization still applies to a lot, though. Under the 2026 Medicare Advantage Dual schedule, approval is required for items and services including bone growth stimulators, certain breast reconstruction procedures, injectable chemotherapy and specialty medications, cochlear implants, durable medical equipment above cost thresholds, spine and joint surgeries, gender dysphoria treatments, and inpatient admissions, which require advance notification at minimum.8UHCProvider.com. Medicare Advantage Prior Authorization Requirements Effective May 1, 2026 Emergency and urgent care don’t need prior authorization.9UHCProvider.com. Medicare Advantage Prior Authorization Requirements Effective January 1, 2026
What You’ll Pay
Every Medicare Advantage plan has to cap annual out-of-pocket spending for Part A and Part B services, a protection Original Medicare doesn’t offer. For 2026, the average in-network out-of-pocket maximum across MA plans is $5,421, and for PPOs the average combined in- and out-of-network limit is $9,825.2KFF. Medicare Advantage in 2026: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization Your specific limit under H2228-074 is listed in the plan’s Summary of Benefits.
D-SNPs are built to keep costs low for dual-eligible members, and many of these members receive additional cost-sharing help through Medicaid. That help can cover premiums, deductibles, and copayments a Medicare-only beneficiary would otherwise owe. What you actually pay depends on your Medicaid eligibility category, so ask your state Medicaid office or plan representative how your coverage stacks with H2228-074’s cost-sharing before assuming a bill is yours to pay.
Where to Confirm Your Plan Details
Because H2228-074 can be structured and priced differently by service area, the definitive answers on your network, premium, copays, out-of-pocket cap, and drug formulary live in two documents: your Evidence of Coverage and your Summary of Benefits. Both are available through myAARPMedicare.com. If the plan is no longer offered in your county for 2026, UnitedHealthcare or CMS will send written notice, and you’ll have a Special Enrollment Period to choose another plan.