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UnitedHealthcare Medicare Advantage plans: What to know

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.
NameUnited HealthCare Providers
united healthcare providers phone number1-800-474-4467 or 1-888-842-4571
uhc provider login click here
united healthcare community planUnitedHealthcare Connected® (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid
unitedhealthcare dentalhttps://www.uhc.com/dental-vision-supplemental-plans/dental-insurance
united healthcare parekh loginhttps://www.uhcpindia.com/web/login/customerlogin.aspx

UHC and Medicare Advantage

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
  • acupuncture
  • chiropractic care
  • over-the-counter benefit in which a person can save a minimum of 40% on over-the-counter medication

Types of Medicare Advantage plans

There are four main types of Medicare Advantage plans:

Each plan has different rules and benefits, but all must cover the same standard services found in original Medicare policies.

UHC HMO plans

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:

  • dental
  • fitness and wellbeing benefits
  • hearing
  • vision

The fitness and wellbeing benefit, known as Renew Active, includes gym membership, group fitness classes, and online mental agility training.

Provider networks

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.

Costs

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

UHC PPO plans

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.

UHC PFFS plans

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.

UHC SNP plans

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.

Choosing and enrolling

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.

Enrollment

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:

  • online
  • 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.

Summary

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.

Statistics for United Health Care Providers on Doctor.com

source : UHCprovider.com UnitedHealthcare’s home for Care Provider information with 24/7 access to Link self-service tools, medical policies, news bulletins, and great resources to support • https://www.uhcprovider.com/ – Find provider resources and information | UnitedHealthcare – https://www.uhc.com/provider • https://www.medicalnewstoday.com/articles/united-healthcare-medicare-advantage • UnitedHealthcare Medicare Advantage plans: What to know | Doctors who accept United Health Care Insurance | Doctor.com Top 10 United Health Care Provider Specialties: Dentist (58286 providers); Internist (53427 providers); Family Doctor (53042 providers); Pediatrician (Kids / Children *

How UnitedHealth Group Makes Money

Premiums on risk-based products and fees for health services drive revenue.

Among the middlemen tasked with making today’s healthcare efficient and cost-effective is UnitedHealth Group Inc. (UNH), the world’s largest healthcare company by revenue. UnitedHealth Group generates revenue from a variety of sources, including premiums on risk-based products, fees from various services, sales on healthcare products, and services and investment.

UnitedHealth Group began in 1974 as Minnesota-based Charter Med Incorporated, reorganizing just a few years later into United HealthCare Corporation and eventually into its current structure and name. Throughout its history, the company has acquired a number of competing healthcare providers; most recently, in June of 2019, UnitedHealth Group purchased online patient platform PatientsLikeMe for an undisclosed sum, according to MobiHealthNews

Primarily an insurer, UnitedHealth Group claims over 130 million customers worldwide. The company has two divisions: UnitedHealthcare, its benefits arm, and Optum—a branch that encompasses three separate sectors: OptumRx, a mail-order pharmacy; OptumHealth, which operates health savings accounts; and OptumInsight, a payment processor for healthcare providers. UnitedHealthcare dwarfs Optum, accounting for about 81% of UnitedHealth Group’s revenue in FY 2018.

UnitedHealth Group has a market capitalization of nearly $240 billion as of July 10, 2019. In 2018, it reported $226.2 billion in revenue, up more than 12% from $201.2 billion for 2017. The company’s revenue has ballooned in recent years: for context, in 2014 UnitedHealth Group reported revenues of just under $130.5 billion. Return on equity for 2018 was 24.4%.

UnitedHealth Group’s Business Model

From at least one perspective, health insurance seems like a great deal for the consumer. It provides a sense of security knowing that if you get into an accident or contract a serious illness you’ll be taken care of. Health insurance companies, such as UnitedHealth Group, foot the bill for numerous surgeries and treatments costing tens of thousands of dollars each. So how can this be a good business? The reason is that the healthy customers are essentially paying for the sick ones.

Take, for example, appendicitis. Five percent of the population will get appendicitis at some point in their lives, and many of those will need an appendectomy. The average individual health insurance cost was about $4,700 in 2017 and the surgery is closer to $17,000—hence the people who didn’t need the surgery, the other 95%, cover the ones who do.

Health insurance is one of those phrases that’s gone from clear to idiomatic to bearing no resemblance to its original meaning. Most forms of insurance in other realms involve paying a small amount to insure against the risk of massive loss. Health insurance as it’s currently constituted, at least in the U.S., means partnering with an enormous corporation to pay for even routine maintenance. It’s akin to your home insurance policy covering vacuuming. And, since March 23, 2010, you’re required to use insurance whether you want to or not. The result: 300 million mandated customers and only a handful of approved insurers. The differences among one insurer and the next are often indistinguishable; every giant insurer has to offer health savings accounts, summaries of benefits and coverage, etc. UnitedHealthcare offers cheaper plans than some of its competitors given comparable deductibles, thanks to a larger network of physicians and other medical clients. It should be noted that UnitedHealth Group pulled out of the individual market in 2016.

UnitedHealth Group primarily generates revenue through its premiums, its fees for various medical and consulting services, and sales of medical products and services. It also generates revenue from investments and other income sources, which we will not cover here.

UnitedHealth Group’s Premiums Business

Co-pays cover just about every healthcare transaction that an insurer makes. UnitedHealth Group pays out a lot, but it also takes in a lot. The company billed about $68 billion in Medicare and retirement premiums last year. Advanced-age care comprises UnitedHealthcare’s largest sector, which makes sense, given the relative indisposition of elderly folks. It’s followed by premium revenue from employer and individual plans. People in the workforce have cheaper upfront costs than retirees and they outnumber them greatly. In total, premiums accounted for about $178.1 billion in revenues for UnitedHealth Group in 2018, or nearly 79% of total revenues.

UnitedHealth Group’s Products and Services Business

UnitedHealth Group’s other products and services range from healthcare equipment and tools to consulting and technology, among many others. These are often delivered via consultants, direct sales, or wholesale agents. Products generated $29.6 billion in revenues for 2018, while services brought in $17.2 billion in revenues.

Future Plans

As UnitedHealth Group acknowledges in its 2018 annual review, the U.S. is in the early stages of a dramatic re-envisioning of healthcare thanks to technological development, regulatory changes, and more. The company aims to be at the forefront of these new developments and has already worked to harness new technologies like artificial intelligence (AI) to improve its patient care and product offerings. UnitedHealth Group is also aiming to grow along with changes to the ecommerce and retail landscapes, particularly with regard to its OptumRx platform.

Key Challenges

As an insurance company making most of its money from premiums, UnitedHealth Group always faces the risk of miscalculating medical and administrative costs. With 80-85% of premium revenues going to pay the costs of healthcare delivered to its customers, UnitedHealth Group has a relatively slim margin for error in these calculations.

An Uncertain Future for Healthcare

Another major challenge is the constantly shifting regulatory landscape, which holds tremendous power over healthcare companies. With the Affordable Care Act still a highly contentious political issue, UnitedHealth Group must position itself to be able to adjust its business model in the face of potential changes in regulation.

Given its significant number of customers, UnitedHealth Group is particularly vulnerable to information breaches, cyber attacks, and similar challenges as well.