UnitedHealthcare is a Medicare-approved insurance company that provides Medicare Advantage (Part C) plans. Benefits vary depending on where a person lives and the type of policy they choose.
Original Medicare (parts A and B) is an insurance plan for those ages 65 and over. Medicare Part A covers inpatient care and Medicare Part B covers outpatient and preventive services, as well as a limited number of prescribed drugs.
Private insurance companies approved by Medicare administer Medicare Advantage (Part C) plans. These policies combine the benefits of Original Medicare into one plan, and can also include some additional services.
UnitedHealthcare (UHC) is one of the companies that administers Medicare Advantage, Medicare supplement insurance (Medigap), and Medicare prescription drug plans (Part D).
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
UHC is one of the largest healthcare providers in the United States, with one of the largest networks of hospitals and participating healthcare professionals.
According to a report by the nonprofit KFF, UnitedHealthcare Medicare Advantage plans will be available in 87% of counties across the United States in 2025.
UHC offers a variety of Medicare Advantage policies, but not all plans are available in all parts of the country. Plan benefits may also vary by location.
Key Features
Key features of most UHC Medicare Advantage plans include:
- fitness programs, such as Renew Active
- dental coverage with a $0 copayment with in-network dentists
- vision benefits with a $0 copayment on annual eye exams
- hearing benefits with $0 hearing tests and low copayment hearing aids
- virtual medical visits via computer, tablet, or smartphone
- preventive services with $0 in-network copayments, such as mammograms and colonoscopies
- over-the-counter (OTC) benefit in which a person can save on OTC medications
Types of Medicare Advantage plans
There are four main types of Medicare Advantage plans:
UHC offers a variety of plan types, depending on where a person lives.
HMO plans
With most HMO plans, a person typically needs to choose a primary care physician to look after their general healthcare.
Specialist visits usually require a referral. However, some services do not need one, such as an annual screening mammogram. Certain services may also require prior approval, and to confirm coverage, a person can contact their plan provider directly.
An individual is required to use providers within their plan’s network, except when needing:
- emergency care
- out-of-area dialysis
- out-of-area urgent care
Using an out-of-network healthcare provider in any other situation can be costly, and a person may have to pay for services out of pocket.
PPO plans
UHC PPOs provide many of the same benefits HMOs offer, but the costs can differ.
Pricing may vary because PPO plans do not usually require a person to choose a primary care physician and a referral to a specialist is not needed.
The plans have a healthcare provider network, but a person can visit any provider they choose. If the chosen treatment or service is outside of the plan network, it will usually cost more.
Most PPO plans include coverage for prescription drugs. If this benefit is not included, rules apply which mean a person cannot have a PPO and prescription drug plan at the same time.
If a person would find it useful to have medication coverage, ensuring their PPO plan has this option may be beneficial.
PFFS plans
PFFS plan providers determine how much they will pay healthcare providers and also how much an individual must pay for their care.
UHC PFFS plans do not have a network of healthcare providers, and a person can visit any provider who accepts the terms of the policy.
Individuals are not required to choose a primary care doctor, and referrals are not typically needed to visit a specialist.
SNP plans
UnitedHealthcare has three types of special needs plans:
- Dual-Eligible plans: are for those who qualify for both Medicare and Medicaid
- Institutional plans: coordinate and oversee care for those living in assisted living facilities
- Chronic condition plans: are created for and tailored to those with specific medical conditions
Medicare requires all SNP plans to provide prescription drug coverage, and most policies need a primary care doctor or a care coordinator to manage healthcare needs.
To see a specialist, a person must obtain a referral unless it is for yearly preventive screenings.
If a person has Original Medicare and lives in the plan’s service area, they can apply for an SNP.
The following table shows a few examples of the Medicare Advantage plans offered by UHC.
| ZIP code | Type of plan | Monthly premium | Out-of-pocket max | Copays |
|---|---|---|---|---|
| 90020 (Los Angeles, CA) | AARP Medicare Advantage from UHC CA-004P (HMO-POS) | $0 | $800 | •$0 PCP •$0 specialist |
| 60608 (Chicago, IL) | AARP Medicare Advantage from UHC IL-5 (PPO) | $0 | $6,700 | •$0 PCP •$45 specialist |
| 33133 (Miami, FL) | UHC MedicareMax Complete Care FL-30 (HMO C-SNP) | $0 | $3,400 | •$0 PCP •$0 specialist |
| 10006 (New York, NY) | AARP Medicare Advantage from UHC NY-0005 (HMO-POS) | $59 | $7,900 | •$0 PCP •$50 specialist |
It can be helpful to receive some guidance when comparing Medicare Advantage plans.
The Medicare website has an online tool that a person may use to search for plans available in their area. Medicare can also be contacted by phone at 800-633-4227.
The State Health Insurance Assistance Program (SHIP) national network also offers advice and general guidance on health insurance matters.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
UnitedHealthcare is approved by Medicare to administer Medicare Advantage (Part C) plans.
There are many plan options available through UnitedHealthcare and some plans have benefits that may not be offered by original Medicare.
Choosing the right plan is important, and a person can check plan options in their area by using Medicare’s online search tool or by contacting their nearest SHIP office.
