2027 UnitedHealthcare Individual Exchange plan information

On Jan. 1, 2027, we’ll be offering UnitedHealthcare Individual Exchange plans1 in 29 states. We’ll also be expanding the service area in 5 states.* 

Final plan designs, benefits, cost shares and service areas for plan year 2027 are pending regulatory approval and subject to change. Please refer to our UnitedHealthcare Individual Exchange plan resources for the latest available information.

Important changes for Arizona, Florida and Texas UnitedHealthcare Individual Exchange plans

We’re now offering new plans featuring a capitated primary care group called Sanitas Medical Center in the Phoenix, AZ, Miami-Dade, FL, and Houston, TX areas, in addition to San Antonio. We’ll continue to offer the Kelsey-Seybold capitated network plans in the Houston area.

More information on these plans can be found in the Interactive Guide or the state specific quick reference guides on the Individual Exchange landing page (located in the state folders near the bottom of the page).

Prepare for 2027 plan members

To help ensure your practice is ready to see these members in 2027, visit our UnitedHealthcare Individual Exchange plans resources to access:

• The new 2027 Individual Exchange plans self-paced interactive guide
• State-specific plan information
• Coverage determination guidelines
• Medical and reimbursement policies
• Pharmacy information
• Prior authorization/notification and referral requirements

You can also prepare by completing the following steps:

• Share information with your staff about your participation and referral requirements 
  • In most states,² these plans don’t require a referral from an in-network primary care provider (PCP) for a member to see a specialist
  • Members must select a PCP to help coordinate their care, or we’ll assign them a PCP after 30 days
• Modify your business processes to recognize referral-required plans, if applicable
• Confirm that your staff has access to submit referrals and check referral statuses, if applicable
• Review the prior authorization list at: Advance Notification and Clinical Submission Requirements
• Review our UnitedHealthcare Individual Exchange Medical & Drug Policies, noting that we’ll conduct site of service medical necessity reviews for all procedures/codes

Questions? We’re here to help.

If you have questions, visit our Individual Exchange plans resources, contact your provider advocate or connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.