New Mexico RHCA Retirees – FAQ
UnitedHealthcare®
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Frequently Asked Questions


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


What is the difference between Original Medicare, Medicare Advantage plans, Medicare Supplement plans, and Senior Supplement 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.

Medicare Supplement plans act as a supplement to "Original Medicare" (Parts A and B). Medicare Supplement plans help to pay for some of the costs, like co-insurance and deductibles that Original Medicare does not cover. If you enroll in a Medicare Supplement plan and need prescription drug coverage, you will need to enroll in a Medicare Part D prescription drug plan also.

Senior Supplement® plans also act as a supplement to Original Medicare, but are only offered through an employer group or plan sponsor. They may have similar benefits as the Federal Medicare Supplement plans, but may also cover state-mandated benefits. If you enroll in a Senior Supplement plan and need prescription drug coverage, you will need to enroll in a Part D prescription drug plan also. Employer groups and plan sponsors commonly offer both a Senior Supplement plan and a separate Medicare Part D prescription drug plan.

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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 be eligible for 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 and Medicare 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?

Keep in mind, if you have the Group Medicare Advantage (PPO) plan, as long as your doctor accepts Medicare, you pay the same cost share as if your doctor was in 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 at 877-246-4190, 8:00 a.m. to 8:00 p.m., local time, Monday through Friday. TTY users, call 711.  

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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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Where do I find out if I have met my deductible or 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 annual deductible and out-of-pocket costs for your health and prescription drug plan, if 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, navigate to 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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Can I change my group-sponsored coverage at any time?

Your former employer or 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, some groups may not allow you to re-enroll in the future. Speak with your former payroll location/HR department or plan sponsor 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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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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New Mexico Retiree Health Care Authority


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IMPORTANT DATES

2021 Open Enrollment Period

Began: 10/01/2020
Ended: 10/30/2020

 

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Last updated: 08.30.2021 at 12:01 AM CT  H2001_020121EMR