2020 medicare advantage plans...pcp pca-1-19-00791-m&r-pres_10042019 17 proprietary information...

2020 Medicare Advantage Plans Florida Individual Benefit Plans

Effective Jan. 1, 2020

Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Overview

UnitedHealthcare Medicare Advantage health maintenance organization

(HMO), preferred provider organization (PPO), and HMO-point of service

(HMO-POS) benefit plans

• Individual UnitedHealthcare Medicare Advantage Plans

- 2020 Medicare Advantage Plan Name Changes

- 2020 Medicare Advantage Plan Benefit Highlights

- New Medicare Advantage Plans

- National PPO Network and Passport

• Ancillary Benefits

• Prescription Drug Coverage

• HMO Referral Requirements

• Member ID Cards

• WellMed Delegation

• Member Surveys

• Additional Information

• Thank You

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Individual UnitedHealthcare Medicare Advantage Plans Offered in Florida


Verify Member Benefits

Benefits may vary by county. You can validate a member’s

eligibility and specific benefits using the eligibilityLink tool in

Link. Go to UHCprovider.com/eligibility for more information.

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Medicare Advantage Name Changes

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To help simplify the member experience, in 2020 all UnitedHealthcare and

AARP® plan names and logos are changing to “Medicare Advantage.”

• AARP® Medicare Advantage (HMO)

• AARP® Medicare Advantage Focus (HMO)

• AARP® Medicare Advantage Plan 2 (HMO)

• AARP® Medicare Advantage (HMO-POS)

• AARP® Medicare Advantage Choice® (PPO)

• AARP® Medicare Advantage Choice® Plan 2 (Regional PPO)

• AARP® Medicare Advantage Choice® Essential (Regional PPO)

• UnitedHealthcare The Villages® Medicare Advantage 1 (HMO)

• UnitedHealthcare The Villages® Medicare Advantage 2 (HMO-POS)

• UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)

For more information, please visit UHCprovider.com/FL > Medicare.


2020 Member Benefit Highlights

• 2020 highlights include:

- $0 premium

– Except UnitedHealthcare The Villages® Medicare Advantage 2 (HMO-POS) H1045-027

- $0 primary care provider (PCP) copays for most plans

– The member ID card lists the PCP and specialist copays

- $0 prescription deductible, all tiers, for all Medicare Advantage HMO plans

- $0 copay for preventive and diagnostic colonoscopies and mammograms

for all UnitedHealthcare Medicare Advantage members

- $0 copay for laboratory services for all UnitedHealthcare Medicare

Advantage members

- Mail order prescription 90-day supply option with a $0 copay – Tier 1 for

all plans, Tier 2 for most plans

– Except AARP® Medicare Advantage Choice Plan 2 (Regional PPO)

- Set copays for outpatient and ambulatory surgery center services

– Potentially lower member copay based on place of service

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New and Updated Medicare Advantage Plans for 2020

UnitedHealthcare® Medicare Advantage Walgreens (HMO C-SNP)

• Available to eligible individual living in Brevard, Charlotte, Collier, Hernando,

Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola, Pasco,

Pinellas, Polk, Sarasota, Seminole, Sumter, and Volusia counties.

• Enrolled members must have one of three chronic conditions:

- Chronic heart failure, diabetes or cardiovascular disorder

- Needs a physician attestation

• Enrolled members have statewide access to all network providers and

nationwide urgent and emergent care coverage.

• Members have potentially lower prescription copays (starting at $0) when

using a retail Walgreens pharmacy.

AARP® Medicare Advantage Choice Essential (Regional PPO)

• New benefit for 2020 – Members receive a $50 Part B rebate

• Available state-wide; R0759-002

• Medicare Advantage benefit plan with no Part D coverage

More information on these plans is at AARPmedicareplans.com.

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Preferred Provider Organization (PPO) Plans

Nationwide Access to Network Care Providers

• In 2020, members enrolled in one of our Florida Non-SNP preferred

provider option (PPO) plans will have nationwide access to care at in-

network costs when using the UnitedHealthcare Medicare national network.

• PPO plan members can also access care from any Medicare-eligible, non-

network care provider at higher out-of-pocket costs.

PPO Plan Features

• PPO plan members have to choose a primary care provider (PCP).

• Referrals are not required.

• Members have open access to the UnitedHealthcare Medicare national

network, replaces Passport (activation no longer required).

• PPO plan members from other states will now have open access to

UnitedHealthcare Medicare network of care providers in Florida.

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UnitedHealth Passport HMO Plans (Excluding SNP)

• UnitedHealth Passport allows members to

receive non-emergency covered services

at the in-network benefit level when

traveling outside their home service area to

a UnitedHealthcare Passport service area.*

• Services include medical, preventive care

and supplemental benefits like fitness,

dental and vision for up to nine consecutive

months of travel.

• Members of referral-required plans do not

need referrals when accessing covered

benefits in a UnitedHealth Passport service

area.

• Members must activate their Passport

coverage by calling the Customer Service

number on their member ID card.

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*Go to UHCprovider.com/FL >

Medicare > choose your plan >

UnitedHealth Passport Travel

Benefits Frequently Asked

Questions for additional

information and service areas.

Sample member ID cards for

illustration only; actual information

varies depending on payer, plan and

other requirements

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Regional PPO Contract Number Change

Updates for 2020:

• AARP® Medicare Advantage Choice® Plan 2 (Regional PPO)

- 2019: R7444-003

- 2020: R0759-001

• AARP® Medicare Advantage Choice® Essential (Regional PPO)

- 2019: R7444-004

- 2020: R0759-002

These plans are available to eligible individuals state-wide. Visit

AARPmedicareplans.com and enter a ZIP code to see all the available

plans and the member benefits for that county.

• Visit AARPmedicareplans.com, enter a ZIP code and locate all the

available plans and the member benefits for that county.

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Ancillary Benefits


Additional Member Benefits

• These are additional benefits available to members of individual plans.

- Fitness program

- Hearing aid coverage

- Over-the-Counter (OTC) program

- Routine vision screening

- Telehealth/virtual visits

Some benefit plans also include:

- Access to a personal emergency response system

- Dental coverage (preventive and comprehensive)

- Eyewear coverage

Solutions for Caregivers will no longer be offered in 2020.

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Renew Active™ Fitness Benefit

• Renew Active is a fitness program for the mind and body. It’s designed to

help our members reach their fitness-related goals – and it’s available at no

additional cost.

• Available to all UnitedHealthcare Medicare Advantage benefit plan

members and includes:

- Standard membership at participating fitness locations.

- An in-person fitness orientation to help get started (available at select

locations).

- Classes to help improve energy, strength, balance, flexibility and

endurance.

- Online brain exercises designed to help keep the mind active.

• Visit myrenewactive.com for more information.

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UnitedHealthcare Hearing Benefit

• Available for members of all UnitedHealthcare Medicare Advantage benefit

plans.

• UnitedHealthcare Hearing

- $0 copay for one routine hearing exam each year

- Copays for hearing aids can be from $375 to $2,075, depending on type

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UnitedHealthcare OTC Benefits

• Members receive a credit amount to spend each quarter

• Members can get their OTC products:

- In-person

- Online

- Over the phone

- By mail

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Vision Benefit

• $0 annual routine eye exam (all UnitedHealthcare Medicare Advantage

plans)

- UHC Vision network care providers

- UnitedHealthcare Medicare network ophthalmologists

• Eyewear credit every two years (select plans)

- Frame allowance of $100 to $300 (select plans)

- Lenses covered in full

– Standard single vision, bifocal, trifocal and progressive lenses

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Medical Telehealth/Virtual Visits

• Available for all UnitedHealthcare Medicare Advantage members.

• Benefit includes unlimited visits, $0 copay, available 24/7/365

• Virtual visits are intended for urgent acute medical situations, such as:

- Cold, flu, sore throat, sinus congestion, skin issues and rashes, heartburn,

diarrhea or vomiting.

• Most members will use American Well (AmWell) for virtual visits.

- amwell.com or the AmWell app

- AmWell verifies eligibility when the member registers

- Member receives a transcript of their visit and can send a copy to their

PCP

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Personal Emergency Response System (PERS)

• Some HMO members can get a Philips Lifeline® personal

emergency response system (PERS) with $0 copay.

• In an emergency, PERS quickly connects the member with a trained

operator who can provide verbal assistance and summon help.

- Device is activated at the touch of a button, and depending on

model choice, may automatically detect falls

- Lightweight, waterproof button can be worn on the wrist or around

the neck

- Wireless or landline compatible – works in any U.S. home with

cellular or telephone service

- No cost for shipping or installation

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Enhanced Dental Benefit

• Members of select UnitedHealthcare Medicare Advantage HMO-POS plans:

- Have access to in-network and out-of-network dental benefits.

- Have an allowance of up to $1,000 for covered preventive and

comprehensive dental services per year, no deductible.

• Preventive and diagnostic services include, but aren’t limited to, exams,

annual x-rays, cleanings, fluoride.

- $0 copay

• Comprehensive services adds coverage for inlays, onlays, crowns, bridges,

build-ups necessary to prepare a tooth for a crown or bridge, non-routine

and non-surgical periodontal services, and extractions of erupted teeth.

- 0 to 50% coinsurance

• Dental care providers listed at uhcmedicaredentistsearch.com – select

National Dental Network.

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Prescription Drug Coverage


Prescription Drug Coverage and Costs

• OptumRx is the preferred mail order pharmacy for Medicare Advantage plan

members.

• $0 copay for a 90-day supply of Tier 1 and Tier 2 drugs

- Available for most UnitedHealthcare Medicare Advantage plans

• $28 copay for 90-day supply of Tier 2 drugs

- Available for AARP® Medicare Advantage Choice® Plan 2 (Regional PPO)

plan members

• Other pharmacies, with other out-of-pocket costs, are available in our

network.

• For more information, visit OptumRx.com or call 800-791-7658.

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AARP® Medicare Advantage (HMO) Referral Requirements


Referral-Required Plan Key Features

• Primary care-focused

• Referrals are required for in-network specialists

- Required for most services

- Go to UHCprovider.com/referrals for information on submitting referrals.

• Admission notification, prior authorization and advance notification

requirements apply.

- Review requirements in the Administrative Guide at

UHCprovider.com/guides.

- See notification and prior authorization submission options when verifying

member eligibility using UHCprovider.com/eligibilityLink.

- Go to UHCprovider.com/priorauth for information on submitting

outpatient and inpatient notifications and prior authorization requests.

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HMO Plan Referral Requirements

• PCP or covering physician with same tax ID

number (TIN) must submit electronic referral.

• Referrals are entered for a specific care

provider, date range and number of visits.

• Referrals are valid up to six months.

• Specialists can view referral information online.

• Any specialist with the same TIN may use an

existing referral.

• Any claim from a specialist TIN within the

referral date range is subtracted from number

of visits.

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Specialist 2

Specialist 1

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Services Not Requiring Referrals

• Referrals are not required for these services when provided by a

participating network care provider:

- Routine annual physical exams, vision or hearing exams

- Medicare-covered preventive services, kidney disease education or

diabetes self-management training

- Any service provided by the member’s PCP or a network care provider

practicing under the same TIN as the member’s PCP

- Any service from a network OB-GYN, chiropractor, optometrist,

ophthalmologist, optician or podiatrist

- Allergy immunotherapy

- Mental health and substance abuse services with behavioral health

clinicians

- Any service from a pathologist or anesthesiologist (not including office-

based or pain management services)

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Services Not Requiring Referrals (cont.)

• Referrals are not required for these services when provided by a

participating network care provider:

- Any inpatient consultations by physicians, including hospitalists

- Any lab services and radiological testing service, not including radiation

therapy

- Durable medical equipment, home health, prosthetic/orthotic devices,

medical supplies, diabetic testing supplies or drugs covered by Medicare

Part B

- Services such as hearing aids, routine eyewear, fitness benefits that may

include a gym membership, or outpatient prescription drugs

- Services obtained under the UnitedHealth Passport program within the

passport service area

• Referrals are not required for any emergency/urgent care services provided

in an emergency room, emergency ambulance, urgent care center or

convenience clinic by a network care provider or an out-of-network care

provider.

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Member ID Cards


Sample Member ID Card: Referral Required

Plan CMS

Contract Number

Sample member ID cards for illustration only; actual information varies depending on payer, plan

and other requirements.

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Referral Required

noted on ID card

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Sample Member ID Card: HMO-POS with No Referral Required



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No Referral Required logo

Plan name

The Villages logo

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Sample Member ID Card: PPO with No Referral Required



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Plan name

No Referral Required

logo

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Print date

Medicare National

Network logo

WellMed Delegation PCPs


WellMed Delegation

• WellMed Medical Management of Florida, Inc. and WellMed Medical

Management, Inc. are affiliates of UnitedHealthcare Insurance Company.

WellMed Medical Management of Florida, Inc. (WellMed), is a Managed

Service Organization that directly employs and contracts PCPs with

Medicare experience.

• Since Jan. 1, 2014, UnitedHealthcare has delegated authority to WellMed to

manage these services for a UnitedHealthcare Medicare Advantage plan

member assigned to WellMed-contracted or employed PCP:

– Utilization management

– Claims payment

– Care and disease management

• A WellMed PCP is responsible for managing care for our members, such as

obtaining referrals and coordinating care with specialists, hospitals and

other care providers who participate in the UnitedHealthcare Medicare

Advantage network.

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WellMed Overview

• WellMed is not a benefit plan. Members are enrolled in a UnitedHealthcare

Medicare Advantage benefit plan and may select a primary care provider

(PCP) contracted with WellMed.

• When a member selects a WellMed PCP, WellMed provides services such

as utilization management, the management of referrals, prior authorization

requests and claims processing.

• UnitedHealthcare Medicare Advantage plan members have access to all of

the specialists, ancillary care providers, facilities and hospitals that are

participating in the UnitedHealthcare Medicare Advantage network of care

providers.

• To learn more about WellMed, review the WellMed FAQ available on

UHCprovider.com/FL > Medicare.

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WellMed Referral Process

• If a member selects a WellMed-contracted or employed PCP, referrals,

claims and prior authorization requests must be submitted through

eProvider Resource Gateway (as shown on the ID card) at

eprg.wellmed.net.

• WELM2 will be listed as the Payer ID on the front of the card.



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Member Surveys


Consumer Assessment of Healthcare Providers and Systems (CAHPS®)

• Each year, the Consumer Assessment of Healthcare Providers and

Systems (CAHPS®) survey gathers feedback from consumers to better

understand their overall health care experience.

• How does CAHPS work?

- From February through June, CAHPS surveys are sent to a random

sample of consumers and health plan members. The survey is managed

by the U.S. Department of Health and Human Services Agency of

Healthcare Research and Quality, and administered by vendors certified

by the National Committee for Quality Assurance (NCQA) and the Centers

for Medicare & Medicaid Services (CMS).

• Consumer participation in the survey is voluntary.

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

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Health Outcomes Survey (HOS)

• The Centers for Medicare & Medicaid Services (CMS) conducts the Health

Outcomes Survey (HOS) annually, which is composed of a baseline survey

and a follow-up survey.

• Both surveys evaluate the care that Medicare Advantage plan members

receive. The follow-up survey is for members who participated in the

baseline survey two years prior. It includes questions about several quality

measures.

• HOS results are dependent on respondents’ answers and their memory of

discussions with you.

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For More Information


Medicare Advantage Plans More Information

• You’ll find information in our Care Provider Administrative Guides at

UHCprovider.com/guides.

• Plan-specific information is at AARPMedicareplans.com

• If you have questions, please contact your Physician Advocate or Provider

Relations or Network Management representative at UHCprovider.com >

Contact Us > Network Contacts.

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Thank you.

UnitedHealthcare contracts directly with Walgreens for this plan; AARP and its affiliates are not parties to that contractual relationship.

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization

with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan's contract renewal with

Medicare.

UnitedHealthcare pays royalty fees to Holding Company of The Villages, Inc. (The Villages) for the use of its intellectual property. The

Villages and its affiliates are not insurers. You do not need to reside in The Villages to enroll. The Villages encourages you to consider

your needs when selecting products and does not make specific product recommendations for individuals.

UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the

general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll. AARP encourages

you to consider your needs when selecting products and does not make specific product recommendations for individuals.

PCA-1-19-00791-M&R-PRES_10042019

© 2019 United HealthCare Services, Inc.

2020 medicare advantage plans...pcp pca-1-19-00791-m&r-pres_10042019 17 proprietary information...

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