UnitedHealthcare Nursing Home Plans are Institutional Special Needs Plans (ISNPs) that provide individualized, closely monitored care to nursing home residents. These plans help coordinate care through Optum nurse practitioners and physician assistants on behalf of UnitedHealthcare.
- UnitedHealthcare Nursing Home Plan (HMO-POS SNP)
- UnitedHealthcare Nursing Home Plan (PPO SNP)
Health Maintenance Organization (HMO) plans have a defined network of contracted physicians and hospitals to provide member care. Generally, members must use these providers to receive benefits for covered services, except in emergencies. Some HMO plans do not require referrals for specialty care.
Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost. Many POS plans offer open access to care providers with no referrals needed.
Preferred Provider Organization (PPO) plans offer members access to a network of contracted 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.
UnitedHealthcare offers Medicare Advantage Special Needs Plans (SNPs) that combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional benefits and services designed to meet the unique needs of identified Medicare consumer populations.
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
- Optum Behavioral Health Referral Process
- Readmission Review Program Clinical Guidelines
- Readmission Review Program Frequently Asked Questions
- Special Needs Plans (SNP) Benefit Plan Name Overview
- UnitedHealthcare Administrative Guide
To learn more about UnitedHealthcare Medicare Advantage plans offered in your area, please visit UHCMedicareSolutions.com and enter your ZIP code.
To learn more about Medicare Part D prescription drug coverage or to access related forms, please review the materials available on UHCMedicareSolutions.com under Our Plans > Medicare Advantage Plans > What Do I Need to Know? > Medicare Advantage Plan Information and Forms.
Reminder for Special Needs Plan Providers
UnitedHealthcare provides Special Needs Plan (SNP) care providers access to SNP beneficiaries' Health Risk Assessments (HRAs) and Individualized Care Plans (ICPs) in a variety of ways including mailing, faxing, uploading to the Provider Portal or placing Individualized Care Plans in the SNP beneficiary's physical and/or electronic chart.
Care providers should be reviewing the SNP beneficiary's Individualized Care Plans and participating with the SNP Interdisciplinary Care Team to coordinate the beneficiary's care. Special Needs Plan care providers can register online at UHCprovider.com to begin accessing and reviewing SNP beneficiary Individualized Care Plans via the Care Conductor App on Link.