What is a Medicare+Choice Preferred Provider Organization (PPO) Plan?
A Medicare+Choice Preferred Provider Organization plan is modeled after many of the health plans available through employers. The PPO plan covers your health care costs in return for a monthly plan premium. In addition, some copayments or coinsurance is required when you use services. A PPO plan has a preferred network of contracted physicians, hospitals and other health care professionals. When you receive services within this preferred network, you receive the maximum benefit allowed by the health plan. You have the option of receiving services outside the preferred network; however, you will pay more for those services usually in the form of higher copayments or coinsurance.
Who is eligible?
Almost anyone entitled to Medicare may join Medicare Complete.* You must:
*Note: In accordance with federal regulations, you may not be able to enroll if you have end-stage renal disease. Contact us for more information.
back to top
How does it work?
UnitedHealthcare contracts with the federal government to administer your health care coverage. The government pays us a monthly amount for each Medicare Complete Choice enrollee, based on Medicare’s average costs to provide original Medicare coverage in your service area.
When you choose Medicare Complete Choice, we administer your Medicare benefits. You use your Medicare Complete Choice identification card in place of your Medicare card. You keep all your Medicare benefits, plus you gain additional benefits through Medicare Complete Choice programs and services.
back to top
How much does it cost?
Medicare Complete Choice is available for a monthly plan premium that varies based on the plan. In addition, you must continue to pay Medicare for your Part B premium, and, if applicable, your part A premium. Contact us for more information.
back to top
Is there prescription drug coverage?
Yes. Medicare Complete Choice covers prescriptions that are prescribed by your physician when filled at a contracted pharmacy or through our convenient mail service program*. Your copay for each 31-day generic prescription and your annual benefit limit is detailed in the Summary of Benefits and Evidence of Coverage. Contact us for more information.
*Higher cost sharing or no benefit may apply for non-contracted pharmacies.
back to top
Can I choose my doctors?
You can use any contracted doctor, specialist or health care facility that's a part of the Medicare Complete Choice preferred network. Please note that the physicians and specialists in our network can change at any time. You also have the option of selecting health care professionals that are outside our preferred contracted network at a reduced benefit level.
back to top
What is a network?
A network is a group of physicians, specialists, hospitals, outpatient centers, home health agencies, pharmacies, lab services and other providers who contract with us to provide you health care services.
back to top
What happens if I go to a doctor who’s not in your network?
You may seek covered health care services outside the network from any licensed Medicare health care professional. When you do, you'll be responsible for higher out-of-pocket costs.
back to top
How do I access specialty care?
We recommend you speak with your primary care physician concerning all of your medical care, but you may directly access specialty care from preferred specialists without a referral. To receive maximum benefits, you must receive services from contracted Medicare Complete Choice health care professionals. When receiving out-of-network care, you will be responsible for higher out-of-pocket costs.
back to top
What if I have a medical emergency while traveling?
You are always covered for emergency health services when you are temporarily traveling outside the Medicare Complete Choice service area.
back to top
What is personalized care coordination?
Our health care coordination programs provide you with information and services to help you stay healthy, fit and in control of your life. We help make it easier for you to get the right care at the right time with programs like:
-
Admission counseling prior to a hospital stay
-
Inpatient care advocacy to help monitor your physician’s orders and ensure that treatment plans are carried out in a timely manner.
-
A Welcome Home! program to help you make the transition from hospital to home.
-
Healthy reminders to encourage you to seek preventive care such as flu shots and screening tests.
-
Care management for individuals with complex health care needs
back to top
Is there a 24-hour information resource available with this plan?
Yes. Optum® NurseLine is available to you and your family members 24 hours a day. NurseLine nurses can provide information to help you take care of a minor problem at home or guide you to outside help when you need it.
back to top
How can I compare my options?
You can compare UnitedHealthcare Medicare Complete Choice and the Original Medicare Plan by requesting a Summary of Benefits from your local UnitedHealthcare representative. To find out more, please contact us.
back to top
Where is UnitedHealthcare Medicare Complete Choice available?
For qualifying counties, please see our list of Medicare Complete Service Areas.
I have other questions.
We’re more than happy to help. Please contact us.
back to top
