LGHIB Retirees – FAQ
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Frequently Asked Questions


Obtain answers to commonly asked questions related to Medicare, your plan, and UnitedHealthcare®.


Who is affected by the change to UnitedHealthcare Medicare Advantage?

All Medicare retirees whose local government units elect to cover their Medicare retirees, and their eligible Medicare dependents, through the LGHIB will be affected by this change and will be automatically enrolled into the UnitedHealthcare® Group Medicare Advantage (PPO) plan effective January 1, 2021.

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How will my benefits change from Blue Advantage to UnitedHealthcare Medicare Advantage?

You will have an enhanced benefit package, which includes lower copays for certain services. In addition, you will have access to many extra benefits including: Silver Sneakers, Real Appeal weight loss program, in-home clinical visits, Solutions for Caregivers, Doctor on Demand or AmWell (with a $0 copay) and many new opportunities for incentives and rewards.

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Will this change my dental coverage?

If your former employer from which you retired provides dental coverage for their active members throught the LGHIP, you will have dental coverage as a Medicare-eligible retiree. This dental coverage will be through Blue Cross and Blue Shield of Alabama (BCBS). You will receive a separate dental card from BCBS.

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Is the plan nationwide?

Yes, this plan offers nationwide coverage which includes all 50 states; all U.S. territories and Washington D.C. Worldwide emergency services are also included. If medical services are needed because of an illness, injury, or condition that you did not expect or anticipate while traveling abroad and you cannot wait until you are back in our plan’s service area, you can seek emergency care and file a claim for the care at a later date.

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Is this the Medicare Advantage plan that is advertised on TV?

No. This is a custom Group Medicare Advantage PPO plan designed exclusively for retirees of the LGHIB. Your new card will have both the LGHIB logo and the United Healthcare logo displayed on the front so that your provider can easily identify the difference. Before January 1, 2021, we will work with UnitedHealthcare to communicate with providers in your area to make sure they know our plan is different.

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What is the difference between Original Medicare and Medicare Advantage plans?

Medicare Part A and Part B are usually referred to as "Original Medicare". Part A offers coverage for your hospital stays, while Part B offers coverage for doctor visits and outpatient care. You receive your benefits directly from the government. Medicare then pays fees for your care directly to the doctors and hospitals you visit.

Medicare Part C plans are usually referred to as Medicare Advantage plans. All Medicare Advantage plans are provided by private insurance companies, like UnitedHealthcare Insurance Company, and they all combine coverage for hospital stays (Medicare Part A) with coverage for doctor visits and other outpatient care (Medicare Part B) into one plan. Some plans include prescription drug coverage (Medicare Part D), plus extra benefits like vision, hearing and dental coverage. Under Medicare Part C, the Medicare Advantage plan pays the fees for your care directly to the doctors and hospitals that you visit.

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When enrolled in a UnitedHealthcare plan, do I have to continue paying my Medicare Part B monthly premiums?

Yes. You must be enrolled in Medicare Part A and Part B to be eligible for our retiree plans and you must continue to pay your Part B premium to the government. This is a requirement for Medicare Advantage, Medicare Part D prescription drug, Medicare supplement, and Senior Supplement plans. If you stop paying your Part B premium, you may be disenrolled from your plan.

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Is my doctor included in the UnitedHealthcare Medicare Advantage Network?

To find doctors or hospitals in our network, see the online Provider Directory. This directory is updated regularly to provide you with the current listing of network providers. If you would like help finding a network doctor or to request a written copy of the Provider Directory, please call Customer Service.

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What if my doctor does not have a contract with UnitedHealthcare?

The UnitedHealthcare® Group Medicare Advantage (PPO) plan does not require a doctor to have a contract with UnitedHealthcare. Under this plan, you may see any doctor (in-network or out-of-network) and doctors without a contract will be paid the same reimbursement as they receive from Medicare. Most doctors accept this type of plan once they understand they do not need a contract and they will be paid the same as Medicare. Beginning in September, you will be able to contact UnitedHealthcare with any questions regarding your new plan. UnitedHealthcare will communicate with providers in your area to explain how the plan works and, if necessary, UnitedHealthcare and the LGHIB will contact your provider directly to intervene on your behalf.

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What is the difference between in-network and out-of-network providers?

In-network providers have a contract with UnitedHealthcare. Out-of-network providers do not have a contract. With this plan, you have the flexibility to see any provider (in-network or out-of-network) at the same cost share, as long as they accept the plan and have not opted out of or been excluded from Medicare. Also, when you go out-of-network for care, the plan pays providers just as much as Medicare would have paid. In Alabama, there are over 1,400 in-network providers and over 100 in-network hospitals across the state.

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What happens if my doctor does not accept Medicare?

If your doctor has opted out of the Medicare program in its entirety, you would only have coverage in an emergency situation. Less than 1% of doctors nationally have opted out of the Medicare program.

 

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How are out-of-network claims processed?

Whether your provider is in-network or out-of-network, your provider can submit claims to UnitedHealthcare online. If needed, the UnitedHealthcare claim address information is provided on your UnitedHealthcare Member ID card and in your Plan Details book. UnitedHealthcare processes claims payments for out-of-network providers in compliance with all federal regulations.

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Are there any situations when a doctor will balance bill me?

No. Under this plan, you are protected from any balance billing. If your doctor tries to balance bill you, please contact UnitedHealthcare Customer Service and we will address the issue with the provider directly.

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Is there a hospital deductible?

No. The UnitedHealthcare® Group Medicare Advantage (PPO) plan does not have a hospital deductible.

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What is the maximum number of days covered for hospital admission?

There is no maximum number of days covered for hospital admission. Days are unlimited.

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Where do I find out if I have met my maximum out-of-pocket costs?

This information is accessible within the member portion of the site. Once logged in, click the "Coverage & Benefits" link in the menu at the top of your screen. This page will provide your maximum out-of-pocket costs for your health and prescription drug plan, as applicable.

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Where can I see my latest claims information?

This information is accessible within the member portion of the site. Once logged in, click the "Claims" link in the menu at the top of your screen. The Claims page will enable you to search for medical and/or drug claims by date range and will provide an overview of each claim searched.

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Where can I learn more about the appeals process?

Navigate to the Find and Learn tab in the menu at the top of your screen and click on the File Appeals & Grievances option in the sub-navigation. This page provides detailed information about the appeals process.

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What is the most I will have to spend out-of-pocket for prescription drugs?

Although there is no actual limit on your out-of-pocket prescription drugs expenses, once you have spent $6,350 in drug expenses during the plan year, you will only have to pay a small copay or coinsurance amount for the rest of the plan year.

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What pharmacies are in the plan’s network?

The UnitedHealthcare® Medicare Advantage (PPO) plan includes over 67,000 national chain, regional, local and independent neighborhood pharmacies in the UnitedHealthcare network. Once you are a member with UnitedHealthcare, you will be able to look up pharmacies online or request a printed pharmacy directory by calling UnitedHealthcare Customer Service at the number on the back of your UnitedHealthcare Member ID card. Beginning in September, you can also call UnitedHealthcare Customer Service to check if a pharmacy is in-network, or to get pharmacy contact information.

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What if I have trouble paying for my prescription drugs?

If you have a limited income, you may qualify for the federal Extra Help program to help pay for your prescription drug costs. If you qualify, Extra Help could pay up to 75% or more of your drug costs. Many people qualify and don’t know it. There’s no penalty for applying and you can re-apply every year. Call Social Security toll-free at 1-800-772-1213, TTY 1-800-325-0778, between 7 a.m. – 7 p.m., local time, Monday – Friday.

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Can I change my group-sponsored coverage at any time?

Your plan-sponsor may have specific rules that tell you when you can change or disenroll from your plan. Usually there is a defined "open enrollment" period during which those changes can occur. It's important to understand your group's rules and timing. For example, if you disenroll from your group-sponsored retiree health coverage, you may not be allowed to re-enroll in the future. Speak with your Benefits Administrator to see what applies to you.

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How do I know what changes there will be to my plan for the next year?

Each year that you are a member of a UnitedHealthcare Medicare Advantage or Medicare Part D Prescription Drug plan, you will receive an Annual Notice of Changes (ANOC) about six weeks before your plan's effective date. The ANOC explains any changes in coverage, costs, and benefits that will be effective for the upcoming year. You may also call the customer service number listed on the back for your member ID card with any questions.

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When will I get my UnitedHealthcare Member ID card?

Your UnitedHealthcare Member ID card should arrive in December and you can start using it on your plan effective date of January 1, 2021. Once you receive your card in the mail, you will have full access to the UHC website and the UHC call center. Be sure to provide this new card to your medical and pharmacy providers beginning January 1, 2021.

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Do I need to use my red, white and blue Medicare card?

No, you will only use your UnitedHealthcare® Group Medicare Advantage Member ID card for all covered medical and prescription drug services. Make sure to put your Medicare card somewhere for safe keeping. It is important that you use your UnitedHealthcare Member ID card each time you receive medical services or fill a prescription. Because UnitedHealthcare pays all claims directly, the so claims no longer go to Medicare first. By always showing your UnitedHealthcare Member ID card, you can help make sure that your claims get processed correctly, timely and accurately.

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What do I do if I have lost my member ID card?

This information is accessible within the member portion of the site. Once logged in, click on the "View and Print Member ID Card" link on the home page. 

If you are unable to find the links noted above, please call customer service using the number listed on your plan materials or the number noted for Plan Members on the Contact Us page.

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What is the SilverSneakers® program?

SilverSneakers® helps you stay physically active by providing access to exercise equipment, classes and more at over 16,000+ fitness locations*. SilverSneakers signature classes, offered at select locations, are led by certified instructors trained specifically in adult fitness.

*At-home kits are offered for members who want to start working out at home or for those who can’t get to a fitness location due to injury, illness or being homebound.

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What is the UnitedHealthcare® HouseCalls program?

UnitedHealthcare HouseCalls is an annual wellness program designed to complement your doctor’s care and offered to you for no extra cost. The program sends a licensed health care practitioner to visit you at home. During the visit, they will review your medical history and current medications, perform a health screening, identify health risks and provide health education. It’s also a chance to ask any health questions you may have. Once completed, HouseCalls will send a summary of your visit to your primary care provider so that they have this additional information regarding your health. HouseCalls may not be available in all areas.

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Will I still have access to Teladoc?

You will now have access to Virtual Doctor Visits which allows you to live video chat with a provider from your computer, tablet or smartphone – anytime, day or night, for a $0 copay. UHC’s preferred providers are Doctors on Demand and AMWell.

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What is Medicare Part D IRMAA and does it apply to me?

IRMAA stands for Income Related Monthly Adjustment Amount. Similar to Medicare Part B, high income earners will pay more for their Medicare Part D coverage. If you are a member of a Medicare plan that includes prescription drug coverage and your Modified Adjusted Gross Income on your IRS tax return from two years ago is above $85,000* for an individual or $170,000* for a couple, you may pay an additional amount for Medicare Part D coverage. The extra amount is paid directly to Social Security, not to your plan. If you are subject to IRMAA, Social Security will send you a letter. The letter will explain how they determined the amount you must pay and the actual IRMAA amount. Neither the LGHIB nor your health plan determine who will be subject to IRMAA. Therefore, if you disagree with the amount you must pay, contact the Social Security Administration. You can:

  • Go online to www.ssa.gov
  • Call Social Security toll-free at 1-800-772-1213, TTY 1-800-325-0778 between 7 a.m. – 7 p.m. local time, Monday – Friday
  • Visit your local Social Security office

*These amounts apply for 2020.

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IMPORTANT DATES

2022 Open Enrollment Period

Begins: 11/1/2021
Ends: 11/30/2021

Madison Co Retirees - meeting information

Virtual Education Center 


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Last updated: 09.03.2021 at 12:01 AM CT  H2001_082021EMR