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, and Medicare 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 coinsurance 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.

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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, 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?

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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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  process to appeal decisions related to your benefits.

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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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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, navigate to the bottom of any page and click on the "Print temporary ID card" link. You can also navigate to the "My Plans" tab in the menu at the top of your screen and select the "Order Materials" option in the sub-navigation. The Order Plan Materials page enables you to request a replacement ID card be mailed to you.

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 difference between the PHIP Medicare Advantage plan and an individual Medicare Advantage plan (that I can get somewhere else on my own)?

The PHIP Medicare Advantage Plan is a group insurance plan; most plans that are advertised on TV or in magazines are individual plans. Group insurance plans are purchased by an organization on behalf of a group. Individual plans are purchased by individuals for themselves or their family, either through an insurance company or a broker.

With a group Medicare Advantage plan, the state can negotiate plan enhancements that are not available via individual Medicare Advantage plans. For example, a group Medicare Advantage plan offered through PHIP would not be subject to the prescription drug coverage gap, otherwise known as the “donut hole.”

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How will the medical benefits work?

The medical benefits will be a lot like the other Medicare-coordinated benefits offered by the program, but with Medicare Advantage, you can see any doctor nationwide who accepts Medicare and is willing to treat you and bill UnitedHealthcare. PHIP will release medical benefit comparisons for plan changes in the fall.

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How can I determine if my health care provider is covered by this plan?

The UnitedHealthcare Medicare Advantage plan is a “passive” Preferred Provider Organization, or PPO, meaning you are not restricted to using network doctors, hospitals and other health care providers. You can see any provider that accepts Medicare and is willing to treat you and bill UnitedHealthcare. For covered services, you can continue to see your doctors if they have not opted out of Medicare and agree to see you. Less than 1% of providers have opted out of Medicare.  

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Is this a Medicare Advantage Health Maintenance Organization (HMO) plan with a limited network?

No. This is a national plan that allows you to see doctors and hospitals around the nation, whether they are in-network or out-of-network. This plan will travel with you and your covered dependents throughout the United States. The service area is all counties in all 50 U.S. states, the District of Columbia and all U.S. territories.

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What is a PPO plan?

PPO stands for Preferred Provider Organization. The UnitedHealthcare® Group Medicare Advantage (PPO) plan is a “passive” PPO, meaning retirees are not restricted to using network doctors, hospitals and other health care providers. Retirees pay the same cost share whether they see providers in or out of network, anywhere in the country.

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What happens if I travel outside the U.S. and need medical coverage?

You will have worldwide coverage for emergency and urgently needed care. You may need to pay the entire claim when receiving care and then submit the claim to UnitedHealthcare for reimbursement after returning to the U.S.

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

No. You will only use the UnitedHealthcare Group Medicare Advantage ID card for all covered medical services. You should put your Medicare card somewhere for safe keeping. It is important that you use your UnitedHealthcare ID card each time you receive medical services. Because UnitedHealthcare pays all claims directly, the claims no longer go to Medicare first. By always showing your UnitedHealthcare ID card, you will ensure your claims get processed correctly, timely and accurately.

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If I choose this plan for 2019, can I choose one of the other plan options in subsequent years?

Yes. You have an opportunity to change plans each fall during the Annual Plan Change period.

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Do I need to enroll in Medicare?

Yes. As is the case today, when retirees turn age 65 or first become eligible for Medicare, they must enroll in Medicare Parts A and B. Under the Medicare Advantage Plan, retirees must pay or continue to pay their monthly Part B premium. A retiree who stops paying his or her Part B monthly premium risks losing his or her plan medical and prescription drug coverage.


Will I still have Medicare?

Yes. You will retain all the rights and privileges of traditional Medicare. Under the Medicare Advantage plan, your medical claims will be paid directly by UnitedHealthcare.

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How can I learn more about Medicare Advantage plan option?

PHIP is developing educational materials that will be available before the next plan change period. PHIP will mail information to members in September, host in-person information meetings and offer online learning resources.

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Is this the Medicare Advantage plan that’s advertised on TV?

No. This is a custom Group Medicare Advantage PPO plan designed exclusively for Oregon PERS. This plan is different and should not to be confused with individual UnitedHealthcare Medicare Advantage plans that might be available in the area.

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Does the plan include any benefit enhancements?

Yes, the UnitedHealthcare® Group Medicare Advantage (PPO) plan will provide retirees with access to expanded preventive care as well as new programs and services. Here are just a few examples:

  • SilverSneakers® – A basic fitness membership at thousands of participating gym locations across the country, at no additional cost.
    • SilverSneakers is a fitness program designed for all levels and abilities. It gives you access to exercise equipment, group classes and social events where available. Participating in SilverSneakers may lead to greater strength, improved mental health and increased community engagement.
  • NurseLine – Registered nurses answer retirees’ calls 24 hours a day/7 days a week.
  • HouseCalls – Once a year, retirees can have a health care practitioner visit them in the privacy and convenience of their home. The practitioner will review the retiree’s health history and medication(s), perform a physical exam, identify health risks and provide educational information.
  • Solutions for Caregivers – Support and resources for retirees when caring for a loved one.

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PERS Health Insurance Program


Group retiree benefits for Oregon PERS Retirees

 

IMPORTANT DATES


2020 Plan Change Period

Begins: October 1, 2019
Ends: November 15, 2019

 

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Last updated: 01.21.2019 at 12:01 AM CT  H2001_190115_041206