UnitedHealthcare Group Medicare Advantage plans are only offered to groups such as employers, unions and government sub-entities. These plans provide group retiree Medicare beneficiaries with a variety of health care benefit plan choices, often with more benefits than those provided by Original Medicare. Plan members are still covered under the Medicare program and have federally regulated rights and protections.
Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. Some HMO plans do not require referrals for specialty care.
Preferred Provider Organization (PPO) plans offer members access to a network of contracted local physicians and hospitals, but also allow them the flexibility to seek covered services from outside of the contracted network, usually at a higher cost. Members do not need a referral for specialty care.
We offer a national PPO (NPPO) plan to employers who qualify under a Centers for Medicare & Medicaid Services (CMS) Employer Group Waiver. PPO plans are available as either local PPO (LPPO) or regional PPO (RPPO) offerings.
LPPOs cover certain counties within a state.
Tools and Resources
- Medicare Advantage Copayment Guidelines
- Medicare Advantage Durable Medical Equipment (DME) Frequently Asked Questions
- Medicare Advantage Home Health Services Frequently Asked Questions
- Medicare Advantage Member Rights and Responsibilities
- Medicare Advantage Non-Contracted Provider Dispute and Appeal Rights
- Medicare Advantage Non-Contracted Provider Claim Payment Dispute Request Form
- Medicare Advantage Preventive Screening Guidelines
- Medicare Advantage Prior Authorization Reduction Frequently Asked Questions
- Medicare Advantage Service Area Reduction Frequently Asked Questions
- Readmission Review Program Clinical Guidelines
- Readmission Review Program Frequently Asked Questions
- UnitedHealthcare Group Medicare Advantage (PPO) Network Provider Quick Reference Guide
- UnitedHealthcare Group Medicare Advantage (PPO) Out-of-Network (OON) Provider Quick Reference Guide
- UnitedHealth Passport® Travel Benefits Frequently Asked Questions
- UnitedHealthcare Administrative Guide