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
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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.
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Sample Member ID Card: HMO-POS with No Referral Required
Sample member ID cards for illustration only; actual information varies depending on payer, plan
and other requirements.
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No Referral Required logo
Plan name
The Villages logo
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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Sample Member ID Card: PPO with No Referral Required
Sample member ID cards for illustration only; actual information varies depending on payer, plan
and other requirements.
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Plan name
No Referral Required
logo
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Print date
Medicare National
Network logo
WellMed Delegation PCPs
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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.
Sample member ID cards for illustration only; actual information varies depending on payer, plan
and other requirements.
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Member Surveys
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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.
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© 2019 United HealthCare Services, Inc.