Will My Doctor Accept My UnitedHealthcare Medicare Plan?

Whether or not your doctor will accept your UnitedHealthcare Medicare plan depends on what Medicare plan you have and if your doctor is in your plan network.

UnitedHealthcare networks include 1.2 million physicians and other health care professionals and around 6,500 hospitals and other facilities in the U.S.1

Each type of UnitedHealthcare Medicare plan has different network requirements. Before seeking medical care or services, check with your provider to find out if they accept the terms and conditions of your UnitedHealthcare Medicare plan.

UnitedHealthcare Medicare Advantage Plans

According to the Kaiser Family Foundation, 24 percent of all Medicare Advantage plan beneficiaries in 2017 were members of a Medicare Advantage plan from UnitedHealthcare.2

If you have a UnitedHealthcare Medicare Advantage plan, you may have network restrictions that affect what doctors, hospitals and other providers you can see for covered care. Network restrictions depend on which type of Medicare Advantage plan you have.

Health Maintenance Organization (HMO)

A UnitedHealthcare Medicare HMO plan features a localized network of providers. You are typically required to seek medical care from an in-network provider, except for urgent care, emergency room care and renal dialysis that is out-of-network.

Preferred Provider Organization (PPO)

A UnitedHealthcare Medicare PPO plan also includes a local network of providers, but beneficiaries may also receive care from providers outside of the network. Any covered care you receive outside of your plan network may come with higher out-of-pocket costs.

Point-of-Service (POS)

A UnitedHealthcare Medicare POS plan works similarly to an HMO plan but typically allows you to receive certain medical services outside of the local plan network. Out-of-network care will typically come with a higher cost.

Private Fee-for-Service (PFFS)

A Medicare PFFS plan from UnitedHealthcare gives you the flexibility to see any Medicare-eligible doctor or hospital for your medical care, as long as they agree to accept the plan’s terms and conditions.

UnitedHealthcare Medicare Prescription Drug Plans

Medicare Part D prescription drug plans from UnitedHealthcare offer coverage for many common generic and brand name drugs. You may also be able to get additional savings by filing your prescriptions at a plan-preferred retail pharmacy.

The pharmacy network will vary based on your plan.

UnitedHealthcare Medicare Supplement Insurance Plans

UnitedHealthcare Medicare Supplement Insurance plans are accepted by any doctor who participates in Medicare. Plan availability can vary by state, so you may want to speak with a licensed insurance agent to learn more about what plans are available where you live.

Enrolling in a UnitedHealthcare Medicare Plan

Call TTY Users: 711 24 hours a day, 7 days a week to speak to a licensed agent who can help you get started finding the right UnitedHealthcare Medicare plan for your health care needs.

 

More UnitedHealthcare Articles

 

1 UnitedHealthcare. 2018 Q1 Facts About UnitedHealth Group. (April 2018). Retrieved from https://www.uhc.com/content/dam/uhcdotcom/en/AboutUs/PDF/2018_Q1-FactBook.pdf.

2 Jacobson, Gretchen; Damico, Anthony; Neuman, Tricia; Gold, Marsha. Medicare Advantage 2017 Spotlight: Enrollment Market Update. (Jun. 06, 2017). Kaiser Family Foundation. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

A Private Fee- for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.

Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

You must continue to pay your Medicare Part B premium.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC is a licensed and certified representative of A Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any plan depends on contract renewal.

TZ Insurance Solutions LLC and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. This website does not contain a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877) 486-2048), 24 hours a day / 7 days a week or consult www.medicare.gov.

Not all plans or products are available in all markets. Additional plans may be available in your service area.

Last Updated: 09/04/2018

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