UnitedHealthcare Medicare Advantage 2021 Review

Check out available plans, benefits and ratings of UnitedHealthcare Medicare Advantage and related plans in 2021.

Kate AshfordMay 21, 2021
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UnitedHealthcare is the largest provider of Medicare Advantage plans [1] and offers plans in two-thirds of counties in the United States. UnitedHealthcare also partners with AARP, insuring the Medicare products that carry the AARP name.

Three-quarters of UnitedHealthcare members are in highly rated plans, and UnitedHealthcare gets high marks overall. But the provider ranks fourth out of the large Medicare Advantage providers in a recent member satisfaction survey.

Here’s what you should know about UnitedHealthcare Medicare Advantage.

UnitedHealthcare Medicare Advantage pros and cons

UnitedHealthcare’s offerings have advantages and disadvantages:

Pros

  • Largest network: UnitedHealthcare offers the largest Medicare Advantage network of all companies, with more than 850,000 network care providers [2].

  • Highly rated plans: Although UHC has plans with lower star ratings from the CMS, the provider has 28 contracts rated 4 stars or higher that include 76% of its existing Medicare Advantage members.

  • Home benefits: UnitedHealthcare offers $0 copay telehealth visits, as well as annual home health visits for members who need a house call.

  • Strong advocate network: The provider offers members the chance to work with expert advocates if they have care questions, as well as care coordinators if they’re dealing with complex health issues.

Cons

  • Average member satisfaction ratings: Despite being a behemoth in the industry, UnitedHealthcare's scores in J.D. Powers' recent 2020 Medicare Advantage Study, which measured member satisfaction, were middle-of-the-road [3].

Available Medicare Advantage plans

UnitedHealthcare offers several kinds of Medicare Advantage plans, and they vary in terms of structure, costs and benefits available.

In general, UnitedHealthcare offers Medicare Advantage Prescription Drug Plans, as well as stand-alone prescription drug plans and Medicare Advantage Plans without drug coverage. UHC also offers Medicare Advantage Patriot Plans, which are geared toward veterans and other people with existing drug coverage.

Other plan offerings include the following types:

A health maintenance organization, or HMO, generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.

HMO point-of-service plans are HMO plans that allow members to get some out-of-network services, but you’ll pay more for those services.

Preferred provider organization, or PPO, plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.

UnitedHealthcare’s private fee-for-service, or PFFS, plans allow you to see any Medicare-approved provider who accepts your UnitedHealthcare plan. You won’t have to pick a primary doctor, and you won’t need a referral to see a specialist.

Special needs plans, or SNPs, restrict membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. UnitedHealthcare offers three types of SNPs:

  • Chronic Condition SNP: Designed to meet the needs of members living with certain chronic conditions, such as cardiovascular disorders, diabetes or chronic heart failure.

  • Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.

  • Institutional plans: Provide specialized care to members who live in skilled nursing or assisted living facilities and need an institutional level of care.

Available Part D prescription drug plans

While many of UnitedHealthcare’s Medicare Advantage plans include Part D drug coverage, the company also sells stand-alone Part D prescription drug plans. These plans are meant to accompany Medicare Part A and Part B and do not provide medical coverage.

UnitedHealthcare offers drug coverage through AARP MedicareRx plans. These plans include commonly used generic and brand-name prescription drugs, but different plans offer different kinds of coverage. For instance, the AARP MedicareRx Walgreens (PDP) plan offers $0 copays on Tier 1 drugs at more than 9,200 Walgreens and Duane Reades across the U.S.

UnitedHealthcare offers a number of ways for members to save on drug costs, including the following:

  • Insulin savings: Many UHC Medicare Advantage and Part D plans limit monthly out-of-pocket costs for covered insulin to $35.

  • $0 drug copays: On Dual Special Needs Plans, UHC has removed copays on covered drugs.

  • Bonus drug coverage: Most UHC Medicare Advantage plans will offer bonus drug coverage for common non-Medicare covered prescription drugs. These may include commonly used prescription vitamins like vitamin B12, and drugs for erectile dysfunction.

  • Home prescription delivery: Most plans offer $0 copays for Tier 1 and Tier 2 drugs when members order them through the OptumRx home delivery pharmacy.

Additional benefits

UnitedHealthcare Medicare Advantage offers most MA members access to dental care (and the largest Medicare Advantage dental network), eye exams and discounted hearing aids. Many of its plans offer other benefits as well. Here are a few standouts:

  • Fitness benefits: UnitedHealthcare’s Renew Active fitness program gives members access to a large network of gyms and fitness facilities, as well as local classes and events. Members can also access a library of online workout videos and an online brain health program from AARP Staying Sharp.

  • Over-the-counter allowance: Some plan members may get an allowance they can put toward over-the-counter items like cough and cold meds, first-aid supplies, vitamins and pain relievers.

  • Healthy food benefit: Most Dual Eligible Special Needs Plans will offer a monthly credit, up to $660 per year, to buy fruits and vegetables, meat, seafood, dairy and other healthy items.

  • Healthy rewards: Members may be able to earn up to $120 in rewards for completing health-related tasks, such as getting their annual physical, flu shot, preventive screenings, or by being active and tracking steps.

  • Home health visits: Most plans include HouseCalls, a program that offers members an annual visit with a licensed clinician in their home, which can be used to help manage care.

  • Member advocates: Members with questions about their health and health plan can be matched with expert advocates through UHC’s Advocate4Me program. These advocates can help guide members to help them make informed choices.

  • Care coordinators for complex problems: People facing complex health issues can be paired with a single point of contact to help them coordinate care, manage claims and get support with other needs through UHC’s Navigate4Me program.

  • Telehealth: Nearly all plans offer $0 copays for telehealth visits.

Customer service

UnitedHealthcare members can contact their plan’s customer service in the following ways:

  • Call the number on their member ID card.

  • Chat with a service advocate (available once members log in to their member page).

  • Call 800-721-0627 (TTY: 711) for technical issues 7 a.m. to 10 p.m. Central Time, seven days a week.

  • Connect with UHC on Twitter or Facebook.

UnitedHealthcare service area

UnitedHealthcare offers Medicare Advantage plans and Medicare prescription drug plans in all 50 states and Washington, D.C. Altogether, UnitedHealthcare offers plans in 2,117 counties, or 66% of counties in the U.S. — the second-highest number among providers [4] (Humana tops the list). Eighty-six percent of Medicare beneficiaries have the option of a UnitedHealthcare plan.

Overall, UnitedHealthcare is the largest health insurer in the country [5], and it is the largest among for-profit health plans [6]. More than 6.5 million Medicare beneficiaries are enrolled in a UnitedHealthcare Medicare Advantage plan, and the company added 827,000 new members for the 2021 plan year.

Cost

Costs for Medicare Advantage plans will depend on your plan, your geographic location and your health needs. One of the costs to consider is the plan’s premium, and UnitedHealthcare estimates that 2.5 million members will see $0-premium Medicare Advantage plans in 2021.

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is at least $148.50 in 2021. (Most people pay this standard amount, but if your income is above a certain threshold, you’ll pay more.)

Other out-of-pocket costs to consider include:

  • Whether the plan covers any part of your monthly Medicare Part B premium.

  • The plan’s yearly deductibles and any other deductibles, such as a drug deductible.

  • Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.

  • The plan’s in-network and out-of-network out-of-pocket maximums.

  • Whether your medical providers are in network or out of network, or how often you may go out of network for care.

  • Whether you require extra benefits, and if the plan charges for them.

To get a sense of costs, use Medicare’s Plan Finder to compare information among available plans in your area. You can select by insurance carrier to see only UnitedHealthcare plans, or compare across carriers. You can also shop directly from UnitedHealthcare’s website by entering your ZIP code, and you’ll be able to compare the plans available.

Medicare star ratings

Average Star Rating: 3.9

The Centers for Medicare & Medicaid Services maintains its own database of star ratings on every Medicare Advantage and separate Medicare Part D plan, ranging from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.

Based on the most recent year of data, UnitedHealthcare’s Medicare Advantage plans get an average rating of 3.8, and the company’s prescription drug plans (Part D) get an average score of 3.9. The overall average score for UnitedHealthcare’s plans is 3.9 [7]. For comparison, the average star rating for plans from all providers was 4.06 [8].

That said, three-quarters (76%) of UnitedHealthcare’s Medicare Advantage members who are in rated contracts are in contracts with 4 stars or more in 2021 [9]. Seven Medicare Advantage contracts received 4.5 stars, and four contracts received 5 stars. There were also 22 UnitedHealthcare contracts that were too new to be measured.

To get an overall star rating, the CMS ranks contracts on 46 different plan factors. Here’s where UnitedHealthcare plans really delivered, with average scores of 4.5 (out of 5) and above:

  • Adult BMI assessment (checking to see if members are at a healthy weight).

  • Care for older adults — pain assessment (percent of plan members who had a pain screening at least once during the year).

  • Diabetes care — kidney disease monitoring (percent of plan members with diabetes who had a kidney function test during the year).

  • Complaints about the health plan (more stars mean fewer complaints).

  • Plan makes timely decisions about appeals (percent of plan members who got a timely response when they made an appeal request to the health plan about a decision to refuse payment or coverage).

  • Reviewing appeals decisions (fairness of the plan’s appeal decisions, based on an independent reviewer).

  • Call center — foreign language interpreter and TTY availability (availability of TTY services and foreign language interpretation when prospective members call the plan).

  • Appeals auto-forward (percent of plan members who failed to get a timely response when they made an appeal request to the drug plan; more stars mean fewer delays).

  • Appeals upheld (fairness of drug plan’s appeal decisions, based on an independent reviewer).

  • Complaints about the drug plan (percent of members filing complaints with Medicare about the drug plan; more stars mean fewer complaints).

  • MPF price accuracy (plan provides accurate Medicare Plan Finder drug pricing information for the website).

In some categories, UnitedHealthcare contracts averaged a sub-3 score:

  • Maintaining mental health (percent of plan members whose mental health was the same or better than expected after two years).

  • Medication reconciliation post-discharge (the percent of plan members whose medication records were updated within 30 days after leaving the hospital).

  • Rating of health care quality (member’s rating of health care quality on a scale from 0 to 100).

  • Care coordination (coordination of members’ health care services on a scale from 0 to 100).

  • Rating of drug plan (members’ rating of drug plan on a scale from 0 to 100).

  • Medication adherence for hypertension (percent of plan members taking blood pressure medication as directed).

You can find a plan’s rating with the Medicare Plan Finder.

Third-party ratings

There are a few companies that weigh in on health plans or on the strength of the company in question, and we’ve included two here:

In its 2020 U.S. Medicare Advantage Study — the sixth it's done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on six factors: coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment. On these measures, UnitedHealthcare scored 800 points out of 1,000 (tied with the industry average) and came in fourth out of the top 10 Medicare Advantage providers.

The National Committee for Quality Assurance rates health insurance plans on a 5-point scale (with 5 being best) based on clinical quality, member satisfaction and results from the NCQA Accreditation Survey. The ratings highlight the results of care and what patients say about their care.

In its 2019-2020 ratings of UnitedHealthcare plans (there were no ratings in 2020), NCQA awarded ratings between 4.0 and 2.0, with the bulk receiving 4.0 or 3.5 ratings [11]. Among the company’s plans with ratings, 34 plans received ratings of 4.0. Only one plan (United Healthcare - Texas ) received a 2.0 rating, with low scores on consumer satisfaction and prevention, a category that indicates how well plans provide preventive services.

Alternatives

Compare Medicare Advantage providers

Company

Percent in a 4-star plan or higher

Service area

Average Medicare star rating

87%

46 states and Washington, D.C.

3.7

59%

44 states.

3.8

93%

50 states, Washington, D.C., and Puerto Rico.

3.7

76%

50 states and Washington, D.C.

3.9

26%

27 states.

3.4

Find the right Medicare Advantage plan

It’s important to do your research before selecting a health plan for yourself. Here are some questions to consider asking:

  • What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?

  • Is your doctor in network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.

  • Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?

  • Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?

  • Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?

If you have additional questions about Medicare, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227, TTY 877-486-2048).

ARTICLE SOURCES

  1. Kaiser Family Foundation, “A Dozen Facts About Medicare Advantage in 2020,” accessed May 17, 2021.

  2. Kaiser Family Foundation, “Medicare Advantage 2021 Spotlight: First Look,” accessed May 17, 2021.

  3. Insurance Business America, “Top 10 health insurance companies in the U.S.,” accessed May 17, 2021.

  4. Centers for Medicare & Medicaid Services, “Part C and D Performance Data, 2021 Star Ratings Data Table,” accessed May 17, 2021.

  5. Centers for Medicare & Medicaid Services, “Part C and D Performance Data, 2021 Star Ratings Fact Sheet 10 13 2020,” accessed May 17, 2021.

  6. Centers for Medicare and Medicaid Services, “Monthly Enrollment by Contract, 2021-04,” accessed May 17, 2021.

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