UnitedHealthcare Exchange Plans
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.
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
On 1/1/21, we are expanding our footprint in Colorado and entering the Health Insurance Marketplace (Exchanges) in these states including Arizona, Maryland, North Carolina, Oklahoma, Tennessee, Virginia, and Washington.
To help you prepare for new members participating with Exchange Plans in these 7 states on 1/1/21, please see the following resources:
- Office Readiness Checklist
- Exchange Plans Quick Reference Guide
- Frequently Asked Questions
- Flyer for Your Patients
Learn More on Your State’s Exchange Plans:
- Arizona: UHCprovider.com/AZexchanges
- Colorado: UHCprovider.com/COexchanges
- Maryland: UHCprovider.com/MDexchanges
- North Carolina: UHCprovider.com/NCexchanges
- Oklahoma: UHCprovider.com/OKexchanges
- Tennessee: UHCprovider.com/TNexchanges
- Virginia: UHCprovider.com/VAexchanges
- Washington: UHCprovider.com/WAexchanges
Exchange Plan Policies
- UnitedHealthcare Value & Balance Exchange Medical & Drug Policies and Coverage Determination Guidelines
- Reimbursement Policies for UnitedHealthcare Value & Balance Exchange Plans
Prior Authorization
Pharmacies/Drug/Formularies
- Pharmacy
- Pharmacy prior authorization form (does not apply to Colorado)
- State of Colorado prior authorization form
Training