UnitedHealthcare Medicare Review

Largest US health insurer and Medicare insurance market leader

Reviewed By DEB GORDON  Updated Jan 28, 2021

We publish unbiased product reviews; our opinions are our own and are not influenced by payment we receive from our advertising partners. Learn more about how we review products and read our advertiser disclosure for how we make money.

OUR TAKE

UnitedHealthcare is the market leader in U.S. health insurance.¹ Its Medicare offerings are robust, with a wide range of options and broad national coverage. It offers an app and online tools, numerous extra benefit programs, and telehealth options. UnitedHealthcare plans sometimes cost more than competitors’ plans, though it offers a wide assortment of options at different price points.²

Pros

·        Offers largest national network of providers

·        Recommends plan options that might fit your needs

·        Virtual visits and house calls free available on some plans

·        Only health insurer with AARP endorsement

·        Highly rated plans

Cons

·        Prices can be higher

TABLE OF CONTENTS

·        Pros Explained

·        Cons Explained

·        Available Plans

·        Extra Benefits

·        Customer Service

·        Customer Satisfaction

·        Third-Party Ratings

·        Medicare Star Ratings

·        Cost

·        Competition

·        How We Reviewed Medicare Providers

Pros Explained

·        Offers largest national network of providers: UnitedHealthcare boasts the largest national network of hospitals, doctors, and other healthcare providers—850,000 nationwide—though network size varies by market.

·        Recommends plan options that might fit your needs: UnitedHealthcare’s online plan recommendation tool helps narrow down the choices with recommendations of best-fit plans. Recommendations are based on any specific doctors, medications, travel habits, and other preferences, or you can skip over the details and answer just basic questions.

·        Virtual visits and free house calls available on some plans: UnitedHealthcare has multiple ways for people to get healthcare from home, through virtual visits with a telehealth company and an annual house call. They’ve also waived copayments on telehealth visits with in-network providers during the COVID-19 pandemic; it remains to be seen if they will extend those waivers beyond the national public health emergency. 

·        Only health insurer with AARP endorsement: AARP and UnitedHealthcare have partnered to cobrand Medicare insurance plans. Investopedia chose AARP Medigap plans as the best for set pricing because prices don’t change as you age.

·        Highly rated plans: UnitedHealthcare has four plans with the top quality rating—5 Stars—from CMS, the agency that oversees Medicare. The average 2021 Star Rating for UnitedHealthcare Medicare plans is 3.87, higher than many competitors.²

Cons Explained

·        Prices can be higher: Some UnitedHealthcare Medicare Advantage plans average higher premiums or out-of-pocket maximums than some competitor plans.² You may get more for these higher prices, such as access to a broad national network and extra benefits, but if cost is your primary concern, you may be able to find cheaper options in some markets on some products. 

Available Plans

Medicare Advantage Plans

UnitedHealthcare offers several types of Medicare Advantage plans, including HMO, HMO-POS, and PPO plans among others. Most UnitedHealthcare Medicare Advantage plans include extra benefits like dental, vision, hearing, fitness, and in-network telehealth visits. UnitedHealthcare also boasts the largest Medicare Advantage network of doctors, specialists, and other healthcare providers, though network size varies by market. UnitedHealthcare has waived consumer costs for telehealth visits with in-network providers; out-of-network telehealth services are covered according to specific plan rules. 

HMO Plans 

These plans require members to get all their care within the HMO network of providers. Many of these plans include prescription drug coverage and allow members to see providers around the country via the UnitedHealthcare Medicare National Network for in-network rates, and UnitedHealthcare Passport, which covers members for certain services with the costs of the HMO network while traveling. For 2021, UnitedHealthcare offers 2,555 Medicare Advantage HMO plans with prescription drug coverage and 574 HMO plans without prescription coverage.²

HMO-POS Plans 

HMO-POS (Point of Service) plans are like HMO plans but offer somewhat more flexibility to see healthcare providers outside of a specific network than HMO plans. Members in UnitedHealthcare’s HMO-POS plans can get some covered services outside the HMO network but out-of-network care costs more. 

PPO Plans

UnitedHealthcare’s PPO plans don’t require members to choose a PCP or get referrals to see in-network specialists or hospital visits. Many of these plans provide access to the UnitedHealthcare Medicare National Network at in-network prices. For 2021, UnitedHealthcare offers 3,284 local and regional PPO plans with prescription drug coverage and 1,102 without.² 

Private Fee-for-Service Plans 

UnitedHealthcare’s Private Fee-for-Service (PFFS) plans have no provider network, which means members can get care from any doctor, hospital, or other healthcare provider so long as they participate with Medicare. UnitedHealthcare PFFS plans without prescription drug coverage can be paired with a Stand-Alone Prescription Drug Plan. UnitedHealthcare offers 80 PFFS plans with prescription drug coverage and 80 PFFS plans without prescription drug coverage. These plans are available in seven states (Kansas, Kentucky, Missouri, Montana, Nebraska, Oklahoma, and Wyoming).

Dual-Eligible Special Needs Plans (D-SNP) 

Dual-Eligible Special Needs plans (D-SNP) are a type of Medicare Advantage plan for people who have both Medicare and Medicaid.⁴ D-SNPs offer the benefits of Medicare Advantage with additional benefits the private insurer may choose to include. UnitedHealthcare’s D-SNP plans, called UnitedHealthcare Dual Complete, help people coordinate care and benefits, and typically include extra benefits such as dental care, vision coverage, free rides to and from doctor visits and pharmacies, and credits to buy health products over the counter and healthy foods at local retailers. All of UnitedHealthcare’s D-SNP plans include prescription drug coverage. In 2021, UnitedHealthcare removed copayments on covered drugs in most D-SNP plans. 

Stand-Alone Prescription Drug Plans 

Stand-Alone Prescription Drug Plans (PDP) cover medications that fall into the Medicare coverage gap. On UnitedHealthcare’s website, you can estimate the cost of specific drugs and compare those costs on PDPs versus Medicare Advantage Prescription Drug Plans (MAPDs). UnitedHealthcare offers three PDP categories, in partnership with AARP, each with slightly different costs, coverage, and drug lists: 

·        AARP MedicareRx Walgreens: Low premiums and access to 9,200 Walgreens and Duane Reade pharmacies nationwide 

·        AARP MedicareRx Preferred: No deductibles, and coverage of most generic and brand-name drugs covered by Medicare Part D

·        AARP MedicareRx Saver Plus: Low copayments on many generic and some brand-name drugs, best for people who want coverage but don’t take a lot of medications

Medicare Supplement Insurance (Medicap) Plans

Medicare Supplement plans, also known as Medigap, cover some of the costs that Original Medicare doesn’t cover like copayments, coinsurance, and deductibles. You must have Medicare Parts A and B, and you can’t have Medicare Advantage, to get a Medigap plan. There are 10 standardized plans that cover different costs; not all are available in every state. 

UnitedHealthcare Medigap plans are the only ones endorsed by AARP. UnitedHealthcare offers several Medigap options: 

·        UnitedHealthcare offers Medigap Plans A, B, C, D, F, G, K, L, M, N

·        AARP offers Medigap plans insured by UnitedHealthcare, including Plans A, B, C, F, G, K, L, N

All Medigap plan benefits are the same no matter the insurer, but costs and any additional benefits can vary. 

Extra Benefits

Most Medicare Advantage plans offer extra benefits, such as fitness, dental, and vision benefits, as well as hearing aids, over-the-counter medications, and meal benefits. UnitedHealthcare offers a robust set of extra benefits, including dental, vision, and hearing benefits. The UnitedHealthcare Renew Active program offers free gym memberships, workout videos, and an online brain health program from AARP's Staying Sharp. 

Other extra benefits include:

·        Over-the-Counter Benefits: UnitedHealthcare offers FirstLine, a program that gives members an allowance for over-the-counter health products like vitamins and pain relievers. 

·        In-Home Visits: Through the UnitedHealthcare HouseCalls program, most Medicare members can get a free annual in-home visit with a doctor, nurse, or medical assistant, who performs a physical exam and health screenings. These providers share the information from the visit with members’ primary care doctors and leave members with a checklist to discuss with their primary care doctors at their next visit.  

·        Telehealth: UnitedHealthcare offers virtual visits on many of its plans, including Medicare Advantage. These online consultations are through telehealth services such as Teladoc, American Well, or Doctor on Demand. Not every plan includes this benefit. UnitedHealthcare Medicare Advantage plans include coverage for telehealth visits. COVID-19 testing-related remote visits have $0 copayments through the national public health emergency period. 

Customer Service

UnitedHealthcare offers many ways to get customer service, including by phone, online, mail, and in-person. 

Medicare Advantage 

Prospective members interested in learning more about UnitedHealthcare Medicare Advantage options can call 877-596-3258 between 8 a.m. and 8 p.m. local time, seven days a week, or make an appointment to meet with an agent.

Current members call the customer service phone number on the back of their member ID card between 8 a.m. and 8 p.m. local time, seven days a week. 

When you first visit the UnitedHealthcare website, you may be offered a chat option, though you’ll have to enter some basic personal information to begin. 

Medicare Prescription Drug Plans 

Current members call the customer service phone number on the back of their member ID card between 8 a.m. and 8 p.m. local time, seven days a week. 

Dual-Eligible Special Needs Plans 

UnitedHealthcare also offers a UnitedHealthcare app where members can find and have video chats with in-network health care providers, view their claims and payments, get cost estimates, and refill prescriptions. You can chat with UnitedHealthcare representatives via Facebook and Twitter seven days a week, via direct message.

Customer Satisfaction 

The National Association of Insurance Commissioners (NAIC) tracks complaints against insurers of all types, including health insurers. In its complaint index, NAIC divides the company’s share of complaints by its share of premiums in the U.S. market.⁵ A score of less than 1.0 means the insurer received fewer than expected complaints; a score of greater than 1.0 means they received more than expected. 

UnitedHealthcare’s complaint index for the UnitedHealthcare Insurance Company was 1.09 in 2019, slightly above the expectation, across all lines of insurance. The Medicare Supplement and Medicare Advantage lines of business had just 55 and 23 complaints, respectively. In 2018, the overall complaint index was .72, with 44 Medicare Supplement complaints and 24 Medicare Advantage complaints. In 2017, the complaint index was 0.83, with 41 Medicare Supplement and 25 Medicare Advantage complaints. 

Third-Party Ratings

AM Best

UnitedHealthcare operates a number of subsidiaries which are reviewed by AM Best. AM Best gave each UnitedHealthcare entity it reviewed an A (Excellent) Financial Strength Rating.⁶ For UnitedHealth Group, the parent company of UnitedHealthcare, AM Best affirmed its A- (Excellent) rating. An A or A- rating indicates that the company, in AM Best’s opinion, has an excellent ability to meet their ongoing insurance obligations. 

NCQA

The National Committee for Quality Assurance (NCQA) is a leading health plan accreditation organization that rates plans based on health care quality and customer satisfaction measures. In the 2019–2020 ratings, UnitedHealthcare plans scored between 2.0 to 4.0 out of 5.0.⁷ These composite scores include measures of customer satisfaction, satisfaction with the doctors, and satisfaction with the health plan. 

 

Some UnitedHealthcare plans that don’t score high in NCQA’s overall health plan rating do better on member experience measures and some score well overall but poorly on member experience with the health plan. 

J.D. Power

In its 2020 U.S. Medicare Advantage Study, J.D. Power measured member satisfaction with Medicare Advantage plans based on the plans’ coverage and benefits, choice of health care providers, cost, customer service, information and communications, and billing and payment processes.⁸ On the overall customer satisfaction index, UnitedHealthcare ranked fourth overall with a score of 800 points out of 1,000, placing just at the industry average of 800.

Medicare Star Ratings

The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage and Prescription Drug Plans on a five-star quality rating system. These ratings incorporate member complaints into the overall rating. Star Ratings vary by state, county, and plan. 

In the 2021 Star Ratings, UnitedHealthcare’s plans received between 3.0 and 5.0 out of 5.0 Stars. The average UnitedHealthcare Star Rating is 3.87 overall. Their Medicare Advantage Part C plans average 3.77 Stars and their Part D Prescription Plans score an average of 3.89. Four UnitedHealthcare plans get the top score (5.0) and seven plans earned 4.5 out of 5.0.⁹ 

Cost

Medicare health plan costs depend on many factors, including where you live, which type of coverage you want, and what insurance company you choose. 

Details on premiums, copayments, coinsurance, deductibles, and out-of-pocket maximums for each plan are available on the UnitedHealthcare website. UnitedHealthcare’s Medicare Advantage 2021 price ranges include:²

HMO plans with prescription drug coverage:

·        Monthly premiums range from $0 to $199, averaging $20.59; just over half the plans have no premiums. 

·        Deductibles range from $0 to $445, averaging $113.68; nearly half (44%) half have no deductible.

·        Annual out-of-pocket maximums for in-network services range from $1,000 to $7,550, averaging $4,840.

HMO plans without prescription drug coverage:

·        No monthly premiums or deductibles.

·        Annual out-of-pocket maximums for in-network services range from $3,200 to $6,700, averaging $4,591.

Local and regional PPO plans with prescription drug coverage: 

·        Monthly premiums range from $0 to $112, averaging $25.89; one-third (36%) of plans have no premiums.

·        Deductibles range from $0 to $445, averaging $239.34.

·        Annual out-of-pocket maximums for in-network services range from $3,000 to $7,550, averaging $6,116.

Local and regional PPO plans without prescription drug coverage:

·        No monthly premiums or deductibles.

·        Annual out-of-pocket maximums for in-network services range from $4,300 to $6,700, averaging $6,122.

Private Fee-for-Service plans (PFFS) with prescription drug coverage: 

·        Monthly premiums for all UnitedHealthcare PFFS plans are $64.

·        The deductibles for all PFFS plans are $295.

·        These plans do not have out-of-pocket maximums, which means there is no cap on what members could have to pay in a year.

PFFS plans without prescription drug coverage: 

·        Monthly premiums for these plans are all $40.

·        These plans do not have deductibles or out-of-pocket maximums.

 

Health plan costs typically require trade-offs; a low-premium plan tends to have higher out-of-pocket costs and vice versa.

UnitedHealthcare’s three PDP categories have a range of costs. 

AARP MedicareRx Walgreens: 

·        Copayments as low as $0 on prescriptions filled at Walgreens pharmacies 

·        $0 copayments on 90-day supplies of Tier 1 drugs through OptumRx Home Delivery 

·        $0 annual deductibles on Tiers 1 and 2, $445 on Tiers 3, 4, and 5

AARP MedicareRx Preferred: 

·        50% off copayments on Tier 1 prescriptions at preferred retail pharmacies

·        $0 copayments on 90-day supplies of Tier 1 and 2 drugs through OptumRx Home Delivery

·        $0 annual deductibles

AARP MedicareRx Saver Plus: 

·        Copayments as low as $1 on prescriptions filled at preferred retail pharmacies

·        $3 copayments on 90-day supplies of Tier 1 drugs through OptumRx Home Delivery 

·        $445 annual deductibles 

Competition: UnitedHealthcare vs. Kaiser Permanente

UnitedHealthcare has the largest share of the Medicare Advantage market (26%), offers the largest provider network nationally, and offers plans in 66% of U.S. counties.¹⁰¹ They score well on quality, according to CMS Star Ratings, with an average of 3.78 out of 5.0 Stars. Kaiser Permanente’s drawbacks are its relatively limited availability—they operate in only seven states. Kaiser Permanente does better on the CMS Star Rating with six out of seven Kaiser Permanente plans receiving a 5.0 for the 2021 plan year, putting their overall average at 4.93. 

Kaiser Permanente also beat UnitedHealthcare on the J.D. Power 2020 Medicare Advantage Study, ranking second overall with a score of 829 out of 1,000 compared to UnitedHealthcare’s 800. They also only offer HMO plans, which can feel restrictive for members who want to be able to see health care providers outside of the HMO network. For quality, Kaiser Permanente is a clear winner if you live in the states they serve. For breadth of choice and products that offer more flexibility, UnitedHealthcare has the edge. 

	UnitedHealthcare	Kaiser Permanente
Number of States Available (Medicare Advantage)	47	7
Medicare Plans	5	1
Customer Service Options	Telephone, online, in person, chat	Telephone, online, in person, chat
AM Best Rating	A- (Excellent)	Not rated
Average CMS Star Rating	3.78	4.93

VERDICT

UnitedHealthcare is the clear market leader in the Medicare market, and offers a full assortment of Medicare insurance products. Though some costs may be higher with some UnitedHealthcare plans, the benefits are robust and the network of health care providers is especially large. Their online tools and user-friendly website, high-quality ratings, and unique partnership with AARP should offer consumers peace of mind.

How We Reviewed Medicare Providers

Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index, and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.

https://www.investopedia.com/unitedhealthcare-medicare-review-5096755