Frequently Asked Questions
Obtain answers to commonly asked questions related to Medicare, your plan, and UnitedHealthcare®.
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.
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.
To find doctors or hospitals in our network, click on “Find a Provider” in the navigation at the top of the page. 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.
Click on the Resources tab in the menu at the top of your screen, then on the Appeals & Grievances link. This page provides detailed information about the appeals process.
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, as applicable.
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.
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 Benefits Administrator to see what applies to you.
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 your member ID card with any questions.
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.
You have several ways to determine if your drugs are covered:
- Refer to the drug list included in the information you received from UnitedHealthcare when you enrolled in the plan..
- Go online to www.UHCRetiree.com/myFlorida click on Prescription Drug Information and use the Prescription drug lookup tool to see if your drugs are covered..
- Call UnitedHealthcare Customer Service at the number listed on the back of your ID card.
If you find that the drug you are taking is not covered, talk to your doctor to see if other options are available. You may be eligible for at least a 30-day supply transition fill, giving you time to talk to your doctor. You or your doctor can request a formulary exception if none of the other covered drugs will work for you. Call UnitedHealthcare Customer Service at the number listed on the back of your ID card.
If you find that the drug you are taking is on a higher cost tier, talk to your doctor to see if another drug in a lower cost tier will work for you. (Note: You will not qualify for a transition fill if your drug moves to a higher cost tier, but is still covered by the Prescription Drug Plan.)
If the drug you are taking requires Prior Authorization, you may be given at least a 30-day supply to give you time to talk to your doctor. If your doctor decides to keep you on the drug, you or your doctor can ask that the drug be covered by calling UnitedHealthcare Customer Service at the number listed on the back of your ID card. If you continue to fill prescriptions for the drug without getting a prior authorization, the drug will not be covered and you may have to pay the full retail price.
There are several reasons why a medication may appear to not be covered. One reason may be that the medication requires a prior authorization. This means the plan needs more information from your doctor to make sure the drug is being used and covered correctly by Medicare for your medical condition. Certain drugs may be covered by either Medicare Part B (doctor and outpatient health care) or Medicare Part D (prescription drugs) depending on how it is used. If you don’t get prior approval, the plan may not cover the drug. Please contact customer service at the number listed on the back of your ID card.
A specialty pharmacy can create and dispense specialty drugs. Specialty drugs are prescription drugs that, in general, require special handling or ongoing monitoring and assessment by a health care professional. You may fill your specialty drug at any retail pharmacy in the network that has the capability, or you may use UnitedHealth Group’s specialty pharmacy, BriovaRx. For assistance locating a pharmacy that can fill your specialty medication, call UnitedHealthcare Customer Service at the number on the back of your ID card.
OptumRx® is your pharmacy for convenient home delivery. For instructions on how you can submit your prescriptions to the mail order pharmacy, please review the Mail order brochure .
Drugs and prices may vary between pharmacies and are subject to change during the plan year. You will never pay more than your copayment amount, but you could pay less
Most people first become eligible for Medicare when they turn 65. This is your initial enrollment period. It’s your first chance to enroll in Medicare Part D. Once you first become eligible for Medicare Part D, there is a 63-day period in which you don’t have Part D or other creditable coverage, you may receive a late enrollment penalty. Creditable coverage is prescription drug coverage that is at least as good as or better than what Medicare provides. The late enrollment penalty is an amount added to the monthly Medicare premium you may have to pay. If you receive a letter from UnitedHealthcare asking for information about your prescription drug coverage history, please respond as quickly as possible to avoid an unnecessary penalty. Once you become a member, more information will be available in your Evidence of Coverage (EOC).