Effective January 1, 2020, UnitedHealthcare Senior Care Options Medicare Advantage plan will launch in your area for members who are currently eligible for both Medicaid and Medicare. Over the past year, we’ve been serving UnitedHealthcare Senior Care Options plan members in 8 Massachusetts counties. We are pleased to be expanding our service area to include Hampshire County in 2020.
2020 Health Plans include:
- UnitedHealthcare® Senior Care Options (HMO D-SNP)
*For specifics on geographical areas served by each plan, reference the Frequently Asked Questions underneath the 2020 Plans section.
As part of a UnitedHealthcare Senior Care Options (HMO SNP) plan, each member has access to an Interdisciplinary Care Team. The Care Team includes the member and the care providers, plus the member’s caregivers, case manager, geriatric support service and coordinator and community health workers.
The care plan is shared with team members using multiple modalities, including fax, email, mail, the provider portal and Community Care. Community Care is a web-based health care management system that helps improve collaboration among individuals on a member’s care team.
UnitedHealthcare Senior Care Options health maintenance organization (HMO) has formed a network of doctors, specialists, community health centers and hospitals. Members can only use doctors who are part of the network.
Learn more on UHC On Air: UnitedHealthcare® Senior Care Options Plan Offered in Massachusetts. Simply sign in with your Optum ID and begin watching.
Health Maintenance Organization (HMO) plans use a 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.
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. POS plans do not require referrals for specialty care.
Preferred Provider Organization (PPO) plans work with a network of contracted local physicians and hospitals, but also allows members 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.
PPO plans are available as either local PPO (certain counties within a state) or regional PPO (RPPO) offerings. RPPOs serve a larger geographic area - either a single state or a multi-state area. RPPOs offer the same premiums, benefits and cost-sharing requirements to all members in the region.
UnitedHealthcare Medicare Advantage Special Needs Plans (SNPs) combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional features and benefits designed to meet the unique needs of identified Medicare consumer populations.
Tools and Resources - UnitedHealthcare Dual Complete® Plans
- HouseCalls Program Overview
- Medicare Advantage Chiropractic and Acupuncture Coverage – Quick Reference Guide
- 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 Service Area Reductions for 2020 Frequently Asked Questions
- Optum Behavioral Health Referral Process
- Readmission Review Program Clinical Guidelines
- Readmission Review Program Frequently Asked Questions
Guides, Policies, Pharmacy Formulary, Provider Directory and Training
- UnitedHealthcare Administrative Guide
- UnitedHealthcare Medicare Advantage Coverage Summaries
- UnitedHealthcare Medicare Advantage Reimbursement Policies
- Additional Medicare Advantage Policies
- UnitedHealthcare Medicare Prior Authorization Requirements
- Dual Complete Medicare Advantage Pharmacy Formulary
- Search for a Care Provider – Dual Complete Medicare Advantage Provider Directory
- UHC On Air - Training and Presentations
Additional Medicare Advantage Plan Information
To learn more about the Medicare Advantage plans offered in your area, visit UHCMedicareSolutions.com and enter your ZIP code.
Medicare Part D Information
To learn more about Medicare Part D prescription drug coverage or to access related forms, 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 Tool on Link.