The Patient Protection and Affordable Care Act (ACA) introduced a new option for consumers to access health insurance using a Health Insurance Marketplace, also known as an Exchange. These online Marketplaces let consumers research, compare and enroll for health insurance plans. 

UnitedHealthcare Exchange plan participation

In 2022, we'll offer Individual Exchange plans in 7 new states. Select your state to view the welcome kit.

• Alabama
• Florida
• Georgia
• Illinois
• Louisiana
• Michigan
• Texas

We'll continue to offer Individual Exchange plans in these states:

• Arizona
• Maryland
• North Carolina
• Oklahoma
• Tennessee
• Virginia
• Washington

In 2020, UnitedHealthcare participated in the Health Insurance Marketplace (Exchanges) in 4 states:  Colorado, Nevada, Massachusetts and New York. 

• The Colorado Exchange Plans are administered by Rocky Mountain Health Plans.  For more information on these plans visit: https://www.rmhp.org/family-individual-health-insurance/healthcare-plans/front-range-plans-from-rmhp
• The Nevada Exchange Plans are administered by Sierra.  For more information on these plans, visit: Nevadahealthlink.com
• The Massachusetts Exchange Plans are administered by UnitedHealthcare.  For more information on these plans visit: uhcprovider.com > Massachusetts > Commercial > UnitedHealthcareNavigate.  (See State specific section for MA Insurance Exchange)
• The New York Exchange Plans are administered by UnitedHealthcare. For more information on these plans visit: uhcprovider.com > NewYork > Commercial > UnitedHealthcare Compass 

Learn more about Individual Exchange plans in 2022

• Office Readiness Checklist
• Exchange Plans Quick Reference Guide

Individual Exchange Plan Policies

• UnitedHealthcare Individual Exchange Medical and Drug Policies and Coverage Determination Guidelines
• Reimbursement Policies for UnitedHealthcare Individual Exchange Plans

Select the guidelines for your state:

• Alabama Coverage Determination Guidelines (Effective 1/1/2022)
• Arizona Coverage Determination Guidelines (Effective 1/1/2022)
• Colorado Coverage Determination Guidelines (Effective 1/1/2022)
• Florida Coverage Determination Guidelines (Effective 1/1/2022)
• Georgia Coverage Determination Guidelines (Effective 1/1/2022)
• Illinois Coverage Determination Guidelines (Effective 1/1/2022)
• Louisiana Coverage Determination Guidelines (Effective 1/1/2022)
• Maryland Coverage Determination Guidelines (Effective 1/1/2022)
• Michigan Coverage Determination Guidelines (Effective 1/1/2022)
• North Carolina Coverage Determination Guidelines (Effective 1/1/2022)
• Oklahoma Coverage Determination Guidelines (Effective 1/1/2022)
• Tennessee Coverage Determination Guidelines (Effective 1/1/2022)
• Texas Coverage Determination Guidelines (Effective 1/1/2022)
• Virginia Coverage Determination Guidelines (Effective 1/1/2022)
• Washington Coverage Determination Guidelines (Effective 1/1/2022)

Prior Authorization

• Individual Exchange Plans - Advanced Notification/Prior Authorization Requirements
• Cardiology
• Radiology

Pharmacy and Formularies

• Find a network pharmacy
• Pharmacy
• Prior Authorization: If a drug requires prior authorization, step therapy, utilization management, or an exception, providers can contact OptumRx.
  • Pharmacy prior authorization form 
    
  • Colorado prior authorization form
  • Illinois Prior Authorization Form
  • Texas Prior Authorization Form
  • Louisiana Prior Authorization Form
• State PDLs:
  • 2022 Alabama PDL
  • 2022 Arizona PDL
  • 2022 Colorado PDL
  • 2022 Florida PDL
  • 2022 Georgia PDL
  • 2022 Illinois PDL
  • 2022 Louisiana PDL
  • 2022 Maryland PDL 
  • 2022 Michigan PDL
  • 2022 North Carolina PDL
  • 2022 Oklahoma PDL 
  • 2022 Tennessee PDL
  • 2022 Texas PDL
  • 2022 Virginia PDL
  • 2022 Washington PDL
• PreCheck MyScript:  Check current prescription coverage and price, including out-of-pocket prescription costs for UnitedHealthcare members at their selected pharmacy. Get information on lower-cost prescription alternatives, if available, to help save members money.

Training

• UnitedHealthcare Individual Exchange Plans in 2022