UnitedHealthcare & Medicare Advantage Plans

Medicare Advantage plans cover everything that is included in Original Medicare as well as additional benefits and expanded coverage. There are several different types of these plans on the market, which are available through government-approved private insurance companies.

UnitedHealthcare (UHC) plans and benefits vary by location. But regardless of what Medicare Advantage plan you end up selecting, you are guaranteed national emergency care coverage. More than 8.2 million people were enrolled in UHC’s various Medicare Advantage plans in 2022.

The insurance provider upgraded several areas of coverage for 2023:

UHC also bolstered existing benefits by decreasing many copays, including $0 copays for virtual doctor visits. The company says 97% of its members are enrolled in a standard plan or critical special needs plan with a $0 copay.

UHC has multiple Medicare Advantage plans and Medicare Supplement Insurance plans available. The exact number of plans and the details of each one depend on where you live. Check UnitedHealthcare’s Medicare plans webpage for specific details.

Health maintenance organization (HMO) plans are a common type of Medicare Advantage offered by companies like UHC. Even for seniors, HMO plans are popular because of their low up-front costs. Premiums are low (sometimes $0), and doctor copays are also low, ranging from $0 to $45 or more, depending on where you live.

But out-of-pocket costs for out-of-network doctors are your responsibility. If you need care and your HMO doesn’t have an in-network physician for you, you’ll have to pay the bills for an out-of-network doctor.

In these plans, you usually must pick a primary care physician that is within the plan’s network. Except for medical emergencies when any doctor can take care of you, you must stay within the UnitedHealthcare HMO network for your care needs. That includes specialists: cardiologists, podiatrists, audiologists, etc. For some specialists, you also may need a direct referral from your primary care physician.

Some seniors might not have an HMO option with UHC. For some group plans, such as a popular AARP plan, the insurer removed HMOs from its plan options. Instead, it offers various HMO-POS plans.

Point of service (POS) plans are ones that give subscribers a list of in-network doctors and providers, usually one that is much longer than the list of doctors in HMO networks. An HMO-POS plan is a combination of the two systems. The hybrid aspect is the out-of-network coverage.

In an HMO-POS plan, you still have a primary care physician but can get some care outside of your network at a higher cost. You typically still need a referral from your primary care physician to see a specialist as well.

Preferred provider organization (PPO) plans deliver the most flexibility of all UHC plans. Subscribers have the most choices of in-network doctors and specialists — but they pay more per month for the ability to have it. The same is true for out-of-network doctor coverage.

Under PPO plans, the insurer pays more for more treatment by specialists. Under some plans provided by UHC, you may not need a primary care physician or referrals to see specialists.

Private fee-for-service (PFFS) plans allow you to use any doctor who participates in Medicare, instead of having to rely on a primary care physician or stay within a certain plan network.

Your specific UHC plan will determine how much you pay for treatment and services when you receive them.

UHC also offers access to special needs plans (SNPs). You must meet certain requirements to qualify, such as being eligible for both Original Medicare and full Medicaid benefits.

Citing the increased needs of seniors in a changing healthcare landscape, UHC bolstered its SNP benefits for 2023 with little to no financial cost to subscribers.

Households on a dual special needs plan (D-SNP) gain combined benefits hikes from UHC in 2023. They get an average yearly allowance between $2,200 and $3,600 to spend on over-the-counter healthy food products (at the store or online) and eligible utility costs.

UHC offers many $0 premium plans, which is a major factor for anyone living on a fixed income. However, no plans are free. All Part B (medical) plans have some costs along the way, from having to meet an annual deductible to having to pay for out-of-network doctors and specialists.

Premiums can range from $0 a month to more than $1,000 a month, depending on your location, your plan and your annual income. Copays for primary care physicians vary based on location – from $0 in Columbus, Ohio, to $45 or more in San Francisco, California. Copays for specialists carry a similar range.

You’re also responsible for any costs associated with your Part D (prescription drug) coverage. UHC has expanded access to more tier 1 drugs with no copays, and more medications are hitting that $0 copay level as well.

You can talk to a knowledgeable Medicare advisor to help you compare Medicare Advantage plans.

One of the pros of opting for UHC is the company’s size. According to a study from 2022, it has more Medicare Advantage enrollees than any other company. In part, this is because of UHC’s diversity of options and availability across the country.

But there are some cons as well. While it is the larger company, UHC has ranked behind Humana and several other companies in terms of customer satisfaction.

And according to the Minneapolis Star Tribune, UHC was sanctioned in 2021 by the U.S. Centers for Medicare & Medicaid Services for not spending enough of its premium revenue on medical benefits. As a result, three UHC Part D programs were prevented from adding new customers in 2022.

In the J.D. Power 2022 U.S. Medicare Advantage Study, UnitedHealthcare scored 808 out of a 1,000-point scale on their overall customer satisfaction index ranking, which was one point below the industry average of 809. For comparison, the Kaiser Foundation Health Plan scored 844, and Humana received 824.

Editor Malori Malone contributed to this article.