UnitedHealthcare is approved by Medicare to administer Medicare Advantage plans. Benefits vary depending on where a person lives and the type of policy they choose.
Original Medicare is an insurance plan for those aged 65 and over. Medicare Part A covers inpatient care and Medicare Part B covers outpatient and preventive services, as well as a limited number of prescribed drugs.
Private insurance companies approved by Medicare administer Medicare Advantage plans, also known as Medicare Part C. The policies combine the benefits of original Medicare into one plan, and can also include some additional services.
UnitedHealthcare (UHC) is one of the companies approved by Medicare to administer Medicare Advantage, Medicare supplement insurance (Medigap), and Medicare prescription drug plans (PDPs).
This article will look at the different types of UHC Medicare Advantage plans, what the plans offer, and more.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
UHC is one of the largest healthcare providers in the United States, with one of the largest networks of hospitals and participating healthcare professionals.
According to a report by the Kaiser Family Foundation, 82% of Medicare beneficiaries have access to UHC Medicare Advantage plans in 2020.
UHC offers a variety of Medicare Advantage policies, but not all plans are available in all parts of the country. Some plan benefits also vary by location.
Key features of most UHC Medicare Advantage plans are:
- fitness programs
- dental coverage with $0 copayment with in-network dentists
- vision benefit with $0 copayment on annual eye exams
- hearing benefits with $0 hearing tests and low copayment hearing aids
- virtual medical visits via computer, tablet, or smartphone
- preventive services with $0 in-network copayments
- chiropractic care
- over-the-counter benefit in which a person can save a minimum of 40% on over-the-counter medication
There are four main types of Medicare Advantage plans:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plan (SNP)
Each plan has different rules and benefits, but all must cover the same standard services found in original Medicare policies.
As with most HMO plans, a person will need to choose a primary care physician to look after their general healthcare.
Specialist visits will usually require a referral, but some services do not need one, such as an annual screening mammogram. Certain services may also require prior approval, and to confirm coverage, a person can contact their plan provider directly.
UHC HMOs provide the same benefits as Medicare parts A and B, but may also include:
- fitness and wellbeing benefits
The fitness and wellbeing benefit, known as Renew Active, includes gym membership, group fitness classes, and online mental agility training.
An individual is required to use providers within their plan’s network, except when needing:
- emergency care
- out-of-area dialysis
- out-of-area urgent care
Using an out-of-network healthcare provider in any other situation can be costly, and a person may have to pay for services out of pocket.
UHC HMO costs can differ but are usually low, with many having no monthly premiums.
Some plans also have no copayments for primary care physician visits and low copays for specialist visits.
UHC PPOs provide many of the same benefits HMOs offer, but the costs can differ.
Pricing may vary because PPO plans do not usually require a person to choose a primary care physician, and a referral to a specialist is not needed.
The plans have a healthcare provider network, but a person can visit any provider they choose. If the chosen treatment or service is outside of the plan network, it will usually cost more.
Most PPO plans include coverage for prescription drugs. If this benefit is not included, rules apply which mean a person cannot have a PPO and prescription drug plan at the same time.
If a person would find it useful to have medication coverage, ensuring their PPO plan has this option may be beneficial.
PFFS plan providers determine how much they will pay healthcare providers and also how much an individual must pay for their care.
UHC PFFS plans do not have a network of healthcare providers, and a person can visit any provider who accepts the terms of the policy.
Individuals are not required to choose a primary care doctor, and referrals are not typically needed to visit a specialist.
In 2020, the UHC MedicareDirect Essential PFFS plan does not include coverage for prescribed medication, but a person can purchase a PDP if they choose.
UnitedHealthcare has three types of special needs plans.
- Dual-Eligible plans are for those who qualify for both Medicare and Medicaid.
- Institutional plans coordinate and oversee care for those living in assisted living facilities.
- Chronic condition plans are created for and tailored to those with specific medical conditions.
Medicare requires all SNP plans to provide prescription drug coverage, and most policies need a primary care doctor or a care coordinator to manage healthcare needs.
To see a specialist, a person must obtain a referral unless it is for yearly preventive screenings.
If a person has Medicare parts A and B, and lives in the plan’s service area, they can apply for an SNP.
It can be helpful to receive some guidance when comparing Medicare Advantage plans.
Choosing a plan
The Medicare website has an online tool that a person may use to search for plans available in their area. Medicare can also be contacted by phone at 800-633-4227.
The State Health Insurance Assistance Program (SHIP) national network also offers advice and general guidance on health insurance matters.
Once a person has chosen a plan that best suits their needs, they can enroll by contacting the insurance company administering the policy.
Applications can usually be made:
- by phone
- by completing a paper form and returning it by mail
A company may send paper forms when requested by phone, but there may also be an option to download and print an application from the plan provider’s website.
Individuals can register for a Medicare Advantage plan when they first become eligible for Medicare. This is known as the initial enrollment period (IEP) and runs for 7 months, beginning 3 months before a person’s 65th birth month.
There are additional enrollment periods for those who are not able to register during the IEP.
UnitedHealthcare is approved by Medicare to administer Medicare Advantage (Part C) plans.
There are many plan options available through UnitedHealthcare and some plans have benefits that may not be offered by original Medicare.
Choosing the right plan is important, and a person can check plan options in their area by using Medicare’s online search tool or by contacting their nearest SHIP office.