What UnitedHealthcare Offers and Who It Serves

UnitedHealthcare is one of the largest health insurers in the United States and offers several types of plans for people 65 and older. The company sells Medicare Advantage plans (also called Part C), Medigap policies (also called Supplement plans), and prescription drug coverage (Part D) through standalone plans. UnitedHealthcare also manages some Medicaid plans in certain states for lower-income seniors.

The type of plan you can choose depends on whether you are already enrolled in Original Medicare (Parts A and B), your income, your state of residence, and what coverage you need. UnitedHealthcare plans are available in most states, though the specific plans offered and their costs vary by location and change each year during the annual enrollment period.

Key Takeaways

  • UnitedHealthcare Medicare Advantage plans combine hospital, medical, and often prescription drug coverage in one plan, with lower monthly premiums than Medigap but higher out-of-pocket costs when you use care.
  • Medigap plans from UnitedHealthcare help pay the costs that Original Medicare does not cover, such as copayments and coinsurance, but do not include prescription drug coverage.
  • You can only enroll in a UnitedHealthcare Medicare plan during specific windows: when you first turn 65, during the annual open enrollment period (October 15 to December 7), or if you experience a may have access to life event.
  • Your costs depend on which plan you choose, your location, and whether you use in-network doctors and hospitals — plans with lower premiums often have higher deductibles and copayments.
  • You can find plan details, compare costs, and review provider networks on Medicare.gov or by calling UnitedHealthcare directly at 1-800-523-5746.

Medicare Advantage Plans from UnitedHealthcare

A Medicare Advantage plan is an alternative to Original Medicare. Instead of going through Medicare directly, you get your hospital and medical coverage through UnitedHealthcare. Most UnitedHealthcare Medicare Advantage plans also include prescription drug coverage, dental, vision, and hearing benefits — things Original Medicare does not pay for. The trade-off is that you must use doctors and hospitals in the UnitedHealthcare network, except in emergencies.

Medicare Advantage plans have a monthly premium (which may be zero), a yearly deductible, and copayments or coinsurance when you see a doctor or go to the hospital. The amount you pay out of pocket is capped each year — once you reach that limit, the plan pays 100 percent of covered services for the rest of the year. Plans vary widely in their premiums, deductibles, and copayments, so comparing the specific plan documents matters more than comparing plan names.

UnitedHealthcare offers several types of Medicare Advantage plans: HMO (Health Maintenance Organization) plans, which require you to use in-network doctors and get referrals for specialists; PPO (Preferred Provider Organization) plans, which let you see out-of-network doctors at a higher cost; and PFFS (Private Fee-for-Service) plans, which work more like Original Medicare but through a private company. The plan type available to you depends on where you live.

Medigap (Supplement) Plans from UnitedHealthcare

If you have Original Medicare (Parts A and B), a Medigap plan from UnitedHealthcare pays some or all of the costs that Medicare does not cover — such as copayments, coinsurance, and deductibles. Medigap plans do not include prescription drug coverage; you buy that separately through a Part D plan if you need it. Medigap plans have a monthly premium but typically no deductible or copayment when you use the plan.

Medigap plans are labeled with letters (Plan A, Plan B, Plan C, Plan D, and so on). Each letter represents a standardized set of benefits, so a Plan G from UnitedHealthcare covers the same things as a Plan G from any other insurer. The difference is the monthly premium. You can compare UnitedHealthcare's Medigap premiums against other insurers to find the lowest cost for the plan type you want.

You have a six-month open enrollment period when you first turn 65 and enroll in Medicare Part B. During this window, UnitedHealthcare and other insurers must sell you a Medigap plan at the lowest available price, regardless of your health history. If you miss this window, you may face higher premiums or be denied coverage in some states. After the open enrollment period, you can still buy a Medigap plan from UnitedHealthcare, but the company can charge more or require medical underwriting.

Prescription Drug Coverage (Part D) Through UnitedHealthcare

UnitedHealthcare offers standalone Part D prescription drug plans for people who have Original Medicare but do not have drug coverage through a Medicare Advantage plan or a former employer. Part D plans have a monthly premium, an annual deductible, and copayments or coinsurance for each prescription. The amount you pay depends on which tier the drug is on — generic drugs cost less than brand-name drugs.

Part D plans have a coverage gap (sometimes called the "donut hole") where you pay more out of pocket after you and the plan have spent a certain amount on drugs. Once your total out-of-pocket spending reaches a yearly limit, the plan pays most of the cost for the rest of the year. The specifics of the coverage gap and the yearly limit change each year.

You can enroll in a Part D plan when you first turn 65, during the annual open enrollment period, or if you lose other drug coverage. If you go without Part D coverage when you are first may be able to access, you may pay a permanent penalty on top of your premium for as long as you have Medicare.

How to Find and Compare UnitedHealthcare Plans

The official place to compare all Medicare plans, including UnitedHealthcare, is Medicare.gov. Go to the "Find Care Providers" or "Compare Plans" section, enter your zip code, and the site will show you all available plans in your area, their premiums, deductibles, copayments, and provider networks. You can also see which pharmacies and doctors are in-network for each plan.

You can also call UnitedHealthcare directly at 1-800-523-5746 (TTY 711) to ask about specific plans, get help comparing options, or request printed plan materials. Medicare also has a 1-800-MEDICARE helpline (1-800-633-4227) where you can speak with a counselor who can answer questions about any Medicare plan, including UnitedHealthcare.

Many states have State Health Insurance information Programs (SHIP) that offer free, one-on-one counseling about Medicare plans. A SHIP counselor can help you understand the differences between plans and may be able to help you enroll. You can find your state's SHIP by calling 1-800-MEDICARE or visiting the Eldercare Locator at 1-800-677-1116.

Enrollment Periods and important date

You can only enroll in or change a UnitedHealthcare Medicare plan during specific windows. The Initial Enrollment Period is the seven-month window around your 65th birthday — three months before, the month you turn 65, and three months after. If you miss this window, you may pay a permanent penalty.

The Annual Open Enrollment Period runs from October 15 to December 7 each year. During this time, you can switch to a different Medicare Advantage plan, switch from Medicare Advantage to Original Medicare, or change your Part D plan. Changes take effect on January 1 of the following year.

If you experience a may have access to life event — such as losing employer coverage, moving to a new state, or becoming may be able to access for Medicaid — you may have a Special Enrollment Period lasting 60 days. This lets you enroll in or change plans outside the normal windows. You must report the life event to Medicare within 60 days to use this period.

Costs and Out-of-Pocket Limits

UnitedHealthcare plan costs vary by plan type, location, and year. Medicare Advantage plans typically have lower monthly premiums than Medigap plans but higher out-of-pocket costs when you use care. Medigap plans have higher monthly premiums but lower or no out-of-pocket costs. Part D plans have monthly premiums plus copayments for drugs.

Every Medicare Advantage plan has an out-of-pocket maximum — once you reach this amount in a year, the plan pays 100 percent of covered services for the rest of the year. This maximum changes each year and varies by plan. Medigap plans do not have an out-of-pocket maximum; you pay the monthly premium and then the plan covers its share of costs.

Your actual costs also depend on whether you use in-network providers. If you see an out-of-network doctor in a Medicare Advantage HMO plan, you may pay the full cost yourself. PPO plans let you see out-of-network doctors, but you pay more. Original Medicare with a Medigap plan lets you see any doctor that accepts Medicare, anywhere in the country.

Frequently Asked Questions

Can I switch from a UnitedHealthcare Medicare Advantage plan to Medigap?

Yes, but timing matters. If you switch during the annual open enrollment period (October 15 to December 7), you can move to a Medigap plan without medical underwriting in most states. If you switch at other times, the Medigap insurer may require medical underwriting or deny you coverage. Some states have different rules, so check with your state insurance commissioner's office.

What happens if my doctor leaves the UnitedHealthcare network?

If your doctor leaves the network mid-year, UnitedHealthcare must give you notice and usually allows you to switch to a different plan without waiting for the annual open enrollment period. Contact UnitedHealthcare to ask about your options. You may also have the right to continue seeing that doctor at in-network rates for a limited time while you find a new doctor.

Do I need to pay a penalty if I did not enroll in Part D when I first turned 65?

Yes, if you did not have other drug coverage. The penalty is about 1 percent of the national average Part D premium for each month you went without coverage, and it is added to your premium permanently. You can enroll in a Part D plan now, but the penalty will explore unless you had creditable coverage (such as through an employer or union) during the gap.

Can I use my UnitedHealthcare Medicare Advantage plan if I travel out of state?

Most UnitedHealthcare Medicare Advantage HMO plans only cover emergency care outside the network. If you travel frequently or live part of the year in another state, a PPO plan or Original Medicare with Medigap may be better. Check the plan documents or call UnitedHealthcare to understand what is covered when you travel.

How do I know if a drug is covered under a UnitedHealthcare Part D plan?

Each Part D plan has a formulary — a list of covered drugs. You can view the formulary on Medicare.gov or UnitedHealthcare's website before you enroll. If your drug is not on the formulary, you can ask UnitedHealthcare for an exception, or you can switch to a different Part D plan during the annual open enrollment period that does cover your drug.