How to determine copays and benefits for MN
Last modified: November 12, 2020
Beginning Jan. 1, 2021, we are offering three Medicare Advantage plans (H7404-001-000, H7404-002-000 and H7404-014-000) in the Twin Cities market. They offer lower copays for members who choose certain practices committed to delivering high-quality care. These health care professionals are referred to as Tier 1 providers.
Members enrolled in these preferred provider organization (PPO) plans have the flexibility to seek covered services both inside and outside of the contracted network. These members may seek care at your facility. The member card shows two copay amounts in the PCP and Specialist areas. Tier 1 providers will collect the first amount or lower amount, and Tier 2 providers will collect the second amount listed. Please see the example card below.
- Tier 1 copay = $0
- Tier 2 copy= $10
ACTION REQUESTED: Please share this information with your front desk staff. It will help them determine whether they should collect Tier 1 or Tier 2 copays. Members will receive their member card with the following message included. The included provider list is NOT an exclusive list. Members may use the Provider Look-Up tool at MyAARPMedicare.com to find providers in our network.
Examples of Tier 1 providers are:
- MHealth Fairview
- Universtiy of Mennesota Physicians
- Entira Family Physicians
- France Avenue Family Physicians
- Richfield Medical Group
- Edina Sports and Family Medicine
- Twin Cities Orthopedics, PA
- Summit Orthopedics
Staff Education Information to Determine Tier Level of Provider
UnitedHealthcare offers several options to determine a provider’s tier level. You may use the Provider Look-Up tool to determine what tier a provider is by visiting Search by Provider, Service or Conditions.
Learn more about Eligibility and Benefits
You can also find tier level and copay information through our Online Resources:
- In Eligibility Search Criteria – Add Member ID and Date of Birth > click Verify Eligibility
- In upper right-hand corner – Verify Payer ID “87726 UnitedHealthcare” and Provider Name
- Eligibility & Benefits Page – Scroll down to Servicing Care Provider to see the tier level.
- Scroll to Popular Services Coverage to determine your copay amount.