Frequently Asked Questions
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.
Senior Supplement plans also act as a supplement to Original Medicare, but are only offered through an employer group or plan sponsor. They may have similar benefits as the Federal Medicare Supplement plans, but may also cover state-mandated benefits. If you enroll in a Senior Supplement plan and need prescription drug coverage, you will need to enroll in a Part D prescription drug plan also. Employer groups and plan sponsors commonly offer both a Senior Supplement plan and a separate Medicare Part D prescription drug plan.
Medicare has rules about what types of coverage you can add or combine with a group-sponsored Medicare Advantage plan. You may only be enrolled in one Group Medicare Advantage plan that has medical and offers a Medicare Part D prescription drug plan.
If after enrolling in UnitedHealthcare Group Medicare Advantage plan offered through the Medical Trust, you enroll in any other Medicare Advantage plan or a stand-alone Medicare Part D prescription drug plan, you will be disenrolled from the Group Medicare Advantage plan offered by the Medical Trust, and you may not be able to re-enroll until the following Annual Enrollment period.
No. This is a custom Group Medicare Advantage (PPO) plan designed exclusively for retirees of the Episcopal Church Medical Trust (Medical Trust). This plan is different and should not be confused with individual UnitedHealthcare Medicare Advantage plans that might be available in your area.
Those enrolled or eligible to enroll in the Medical Trust Medicare Supplement Health Plan will continue to be eligible to enroll in the UnitedHealthcare Group Medicare Advantage (PPO) plan. In general, a former employee (clergy and lay) or member of a Religious Order who is age 65 or older, who is entitled to Medicare Part A and enrolled in Medicare Part B, and who earned five years of credited service under a pension plan sponsored by The Church Pension Fund is eligible to enroll in the plan. In certain cases, pre-65 retired employees entitled to Medicare Part A and enrolled in Medicare Part B are also eligible. Special rules apply to former lay employees or members of a Religious Order who did not participate in a pension plan sponsored by The Church Pension Fund. For more information about eligibility, go to www.cpg.org/gmaeligibility.
Your spouse cannot enroll in the UnitedHealthcare Group Medicare Advantage plan until they become Medicare eligible and are enrolled in Medicare Part A and Part B. Contact The Medical Trust to learn about other options at 1-800-480-9967, Monday to Friday, 8:30 AM to 8:00 PM ET.
Yes, you must be enrolled in Medicare Part A and Medicare Part B. You must continue paying your Medicare Part B premium to Social Security to be eligible for coverage under the UnitedHealthcare Group Medicare Advantage plan.
No, Medicare has rules about what types of coverage you can add or combine with a group-sponsored Medicare Advantage plan. You may only be enrolled in one Group Medicare Advantage plan that has medical and offers a Medicare Part D prescription drug plan.
If, after enrolling in UnitedHealthcare Group Medicare Advantage (PPO) offered through the Medical Trust, you enroll in any other Medicare Advantage plan or a stand-alone Medicare Part D prescription drug plan, you will be disenrolled from the UnitedHealthcare Group Medicare Advantage plan offered by the Episcopal Church Medical Trust. You may not be able to re-enroll until an applicable Significant Life Event or Medicare Special Election Period or HIPAA Special Enrollment Event, or until the next Annual Enrollment period.
No. Effective January 1, 2022, both UnitedHealthcare Group Medicare Advantage plan choices offered by the Medical Trust include Medicare Part D prescription drug coverage. The Medical Trust no longer offers medical-only health coverage.
Annual Enrollment is a designated period each year when members may enroll in, or make changes to, healthcare coverage for themselves and/or their dependents. Selected plans become effective on the first day of the following plan year.
Yes, you may change your coverage if you experience a significant life event, such as the death of a spouse, marriage, divorce, retirement, or the return to active compensated ministry. Keep in mind that your coverage change must be directly related to your significant life event. For example, if you get married, you may add your new spouse to your coverage.
No, you should contact us three months before you become eligible for Medicare.
Yes, this plan offers coverage throughout the US and all US territories.
To find doctors or hospitals in our network, click on “Find a Provider” in the navigation at the top of the page. 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.
Under the UnitedHealthcare Group Medicare Advantage (PPO) plan offered through the Medical Trust, you can use any provider who accepts Medicare and the plan.
The UnitedHealthcare Group Medicare Advantage (PPO) plan is a Preferred Provider Organization (PPO) plan. This type of plan generally provides more flexibility to let you choose your providers and hospitals. The plan typically does not require you to have a referral to see a specialist, and you can see providers outside the UnitedHealthcare network without having to pay the entire cost yourself if they are a Medicare-approved provider.
Click on the Resources tab in the menu at the top of your screen, then on the Appeals & Grievances link. This page provides detailed information about the appeals process.
This information is accessible within the member portion of the site. Once logged in, click the "Coverage & Benefits" link in the menu at the top of your screen. This page will provide your annual deductible and out-of-pocket costs for your health and prescription drug plan, as applicable.
An out-of-pocket maximum is the maximum amount of money you would pay for your medical expenses through your copays and coinsurance in a calendar year. Coinsurance is your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service. A copay is a fixed amount you pay for a covered health care service, usually when you receive the service. Your out-of-pocket maximum does not include prescription drug costs or plan premiums.
The UnitedHealthcare Group Medicare Advantage (PPO) plan allows you to see any provider (in-network or out-of-network) at the same cost share for covered services if they accept the plan and have not opted out of or been excluded from Medicare.
However, there are benefits to using UnitedHealthcare in-network providers, including expedited claim payment processing and coordinated healthcare support. If your provider is out-of-network, UnitedHealthcare will be happy to reach out to them to discuss how the plan works and how they will be paid.
If the Medicare provider refuses to accept this plan, you can continue to see the provider, pay for the services up front, and submit the bill to UnitedHealthcare for reimbursement. You will only be responsible for the same copayment or coinsurance as if you had stayed in-network.
Since this is a PPO plan the hospital does not have to be in-network for you to receive services under the plan. For a list of in-network hospitals in the UnitedHealthcare network, contact UnitedHealthcare Customer Service toll-free at 1-866-519-5401, TTY 711, 8:00 a.m. – 8:00 p.m., local time, 7 days a week. Please note that UnitedHealthcare Customer Service will only be able to provide a list of hospitals within the UnitedHealthcare network.
Yes, provided the hospital accepts Medicare and the plan. However, if the hospital does not accept Medicare or the plan, please reach out to UnitedHealthcare prior to receiving services to confirm if the services will be reimbursed.
No. The UnitedHealthcare Group Medicare Advantage (PPO) plan does not have a hospital deductible.
The UnitedHealthcare Group Medicare Advantage (PPO) plan includes over 67,000 pharmacies in the UnitedHealthcare network. Once you are a member, you will be able to look up pharmacies online or request a printed pharmacy directory by calling UnitedHealthcare Customer Service at the number on the back of your UnitedHealthcare member ID card. You can also call UnitedHealthcare Customer Service toll-free at 1-866-519-5401, TTY 711, 8:00 a.m. – 8:00 p.m., local time, 7 days a week to check if a pharmacy is in-network or to get pharmacy contact information.
Yes, prescriptions can be delivered to your home through OptumRx® Home Delivery, a UnitedHealth Group company.
You may need a new prescription. Beginning January 1, 2022, your home delivery pharmacy will be OptumRx, a UnitedHealth Group company. The Quick Start Guide that you will receive will include OptumRx contact information.
OptumRx is an affiliate of UnitedHealthcare Insurance Company. You are not required to use OptumRx Home Delivery to supply your maintenance medication. If you have not used OptumRx Home Delivery, you must approve the first prescription order sent directly from your doctor to OptumRx before it can be filled. Prescriptions from OptumRx should arrive within 5 business days after we receive the complete order. Contact OptumRx anytime at 1-888-279-1828, TTY 711.
It depends on whether or not you had “creditable” prescription drug coverage from the time you first became eligible for Medicare Part D. Creditable coverage means that your prescription drug coverage was at least as good as, or better than, what Medicare requires. If you had a Medicare Part D plan, you had creditable coverage. If you had creditable prescription drug coverage through another source, such as a spouse’s employer plan, you should have gotten a certificate of creditable coverage. If you were eligible for Medicare Part D and you did not have any prescription drug coverage for 63 days or more, Medicare will determine if you need to pay a Late Enrollment Penalty (LEP) for the length of time you were eligible but did not have Part D coverage.
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.
Whether your provider is in-network or out-of-network, they can submit claims to UnitedHealthcare online or send to the address provided on your UnitedHealthcare member ID card. UnitedHealthcare processes claims payments for out-of-network providers in compliance with all federal regulations.
Your UnitedHealthcare member ID card will arrive with your Quick Start Guide before your effective date of January 1, 2023.
No, you will only use your UnitedHealthcare Group Medicare Advantage member ID card for all covered medical and prescription drug services. Make sure to put your Medicare card somewhere for safe keeping. It is important that you use your UnitedHealthcare member ID card each time you receive medical services or fill a prescription. Because UnitedHealthcare pays all claims directly, the claims no longer go to Medicare first. By always showing your UnitedHealthcare member ID card, you can help make sure that your claims are processed in a timely and accurate manner.
This information is accessible within the member portion of the site. Once logged in, click on the "View and Print Member ID Card" link on the home page.
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.