UnitedHealthcare is one company offering Medicare plans, but it is not Medicare itself
UnitedHealthcare is a private insurance company that contracts with Medicare to sell health plans to people 65 and older. Medicare — the federal program — sets the rules and pays the insurance company. UnitedHealthcare then handles your claims, finds doctors and hospitals for you, and decides what it will cover. You pay UnitedHealthcare your monthly premium, not Medicare directly (though Medicare may help pay part of it).
This matters because when something goes wrong with your coverage, you call UnitedHealthcare, not Medicare. When you need to change plans, you work with UnitedHealthcare's enrollment team. But the underlying Medicare benefit — the thing that actually covers your hospital stays and doctor visits — comes from the federal government.
Key Takeaways
- UnitedHealthcare is a private company that sells Medicare plans; it is not the same as Medicare itself.
- UnitedHealthcare offers Medicare Advantage plans (Part C) and Medigap supplemental plans, each with different costs and coverage rules.
- You can change UnitedHealthcare plans during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event.
- Your doctor or hospital may or may not be in UnitedHealthcare's network, so check before you sign up or switch plans.
- If you have a problem with UnitedHealthcare's decision to deny a claim or service, you can file a complaint with Medicare.
The two main types of UnitedHealthcare Medicare plans
Medicare Advantage (Part C) is an all-in-one plan that UnitedHealthcare sells. It covers hospital, doctor, and prescription drug benefits in one policy. You pay a monthly premium to UnitedHealthcare, and you usually have a copay or coinsurance when you see a doctor. Most Medicare Advantage plans have a network — you save money by using doctors and hospitals UnitedHealthcare has contracted with. If you go out of network, you may pay more or the plan may not cover it at all.
Medigap (supplemental insurance) is different. You buy it from UnitedHealthcare to fill the gaps that Original Medicare (Parts A and B) leaves behind. Original Medicare covers some costs but not all. Medigap pays some of your copays, coinsurance, and deductibles. You keep your Original Medicare coverage and add Medigap on top. You can see any doctor or hospital that takes Medicare, because Medigap works with Original Medicare, not with a network.
Some people have both UnitedHealthcare Medicare Advantage and a separate prescription drug plan (Part D). Others have Original Medicare, UnitedHealthcare Medigap, and a separate Part D plan. The combination you choose depends on your health, your doctors, and your budget.
How to learn about UnitedHealthcare plans are available where you live
UnitedHealthcare does not sell the same plans in every state or county. Availability changes year to year. The easiest way to check is to visit Medicare.gov, click "Find Care Providers & Facilities," and enter your zip code. You will see which UnitedHealthcare plans are sold in your area and what they cost.
You can also call UnitedHealthcare directly at 1-877-816-3596 (for Medicare Advantage) or 1-800-624-8822 (for Medigap) to ask what plans they offer near you. Have your zip code ready. Medicare also has a phone line at 1-800-MEDICARE (1-800-633-4227) where staff can tell you which companies, including UnitedHealthcare, sell plans in your county.
What to check before you choose a UnitedHealthcare plan
Before you sign up, make sure your doctors and hospitals are in the plan's network. Call your doctor's office and ask if they accept the specific UnitedHealthcare plan you are thinking about. Network lists change, and a doctor who was in the plan last year may not be this year. If your main doctor is not in the network, you may want to pick a different plan or ask whether you can see that doctor anyway and what it will cost.
Check the prescription drug coverage too. If you take medications, look up each one in the plan's formulary (the list of drugs it covers). Some drugs may have a higher copay, require prior approval from UnitedHealthcare before the pharmacy will fill it, or not be covered at all. If a drug you need is not covered, ask UnitedHealthcare about a coverage exception or consider a different plan.
Look at the out-of-pocket maximum — the most you will have to pay in a year for covered services. For Medicare Advantage, this is usually between $6,700 and $7,000, but it varies by plan. Once you hit that number, the plan pays 100% of covered costs for the rest of the year. For Medigap, there is no out-of-pocket maximum, but your monthly premium is usually higher.
When you can change your UnitedHealthcare plan
The main time to change plans is during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Any changes you make take effect January 1. You can switch to a different UnitedHealthcare plan, switch to a plan from another company, or drop your plan altogether.
You can also change plans if you have a may have access to life event: you move out of the plan's service area, you lose other health coverage, you get married or divorced, or you become newly may be able to access for Medicaid. You have 60 days from the event to make a change. Call UnitedHealthcare or Medicare to report the event and ask what options you have.
If you are unhappy with UnitedHealthcare between enrollment periods and do not have a may have access to event, you are usually stuck with the plan until the next October. The exception is if UnitedHealthcare made a significant change to the plan — such as dropping your doctor from the network or removing a drug you need — that was not announced during enrollment. In that case, you may be able to switch. Call Medicare at 1-800-MEDICARE to ask.
What to do if UnitedHealthcare denies a claim or service
If UnitedHealthcare says it will not pay for something your doctor ordered, you have the right to appeal. Ask UnitedHealthcare for the reason in writing. If it is a service you need right away (like surgery), ask for an expedited appeal, which is faster than the standard process.
You can file a complaint with Medicare if you believe UnitedHealthcare made a wrong decision or treated you unfairly. Call 1-800-MEDICARE and ask to file a complaint, or go to Medicare.gov and use the complaint form. Medicare will investigate and may require UnitedHealthcare to pay for the service or reverse the denial.
Frequently Asked Questions
Is UnitedHealthcare the same as Medicare?
No. Medicare is the federal health program for people 65 and older. UnitedHealthcare is a private company that sells insurance plans under the Medicare program. You pay UnitedHealthcare, and they handle your coverage and claims.
Do I have to use UnitedHealthcare doctors if I have a UnitedHealthcare Medicare Advantage plan?
Most UnitedHealthcare Medicare Advantage plans require you to use in-network doctors to get the best price. You can see an out-of-network doctor, but you will usually pay more. Check your plan documents to see if out-of-network care is covered at all.
Can I have both UnitedHealthcare Medicare Advantage and Medigap?
No. You cannot have Medicare Advantage and Medigap at the same time. You choose one or the other. If you have Original Medicare, you can add Medigap. If you have Medicare Advantage, you do not need Medigap because the Advantage plan covers hospital and doctor services.
What happens to my UnitedHealthcare plan if I move to a different state?
Your plan will end on the last day of the month you move. You will have 60 days to pick a new plan in your new state. Call UnitedHealthcare or Medicare right away to report the move and see what plans are available where you are moving to.
How do I cancel my UnitedHealthcare Medicare plan?
Call UnitedHealthcare at 1-877-816-3596 (Medicare Advantage) or 1-800-624-8822 (Medigap) and tell them you want to cancel. You can cancel during the Annual Enrollment Period or if you have a may have access to life event. If you cancel outside those times, your coverage will end at the end of the month you request it.