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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. Navitus Health Solutions provides Part D to It's Your Choice (IYC) Medicare Advantage members.
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 like Medicare Plus 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. The Medicare Plus plan is a Senior Supplement plan. Navitus Health Solutions provides Part D to Medicare Plus members.
Yes. You must be enrolled in Medicare Part A and Part B to be eligible for our retiree plans and you must continue to pay your Part B premium to the government. This is a requirement for Medicare Advantage, Medicare Part D prescription drug, Medicare supplement, and Senior Supplement plans. If you stop paying your Part B premium, you may be disenrolled from your plan.
*Medicare Plus: If you do not have Part B or lose Part B while enrolled in the Medicare Plus plan, you will be responsible for any costs Medicare would have paid.
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.
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.
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.
Your former employer or plan-sponsor may have specific rules that tell you when you can change or disenroll from your plan. Usually there is a defined "open enrollment" period during which those changes can occur. It's important to understand your group's rules and timing. For example, if you disenroll from your group-sponsored retiree health coverage, some groups may not allow you to re-enroll in the future. Speak with your Benefits Administrator to see what applies to you.
Each year that you are a member of a UnitedHealthcare Medicare Advantage, Medicare Plus , or Medicare Part D Prescription Drug plan, you will receive an Annual Notice of Changes (ANOC) about six weeks before your plan's effective date. The ANOC explains any changes in coverage, costs, and benefits that will be effective for the upcoming year. You may also call the customer service number listed on your member ID card with any questions.
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.
The answer lies in how the federal government reimburses for Medicare-covered services. Under the current structure, traditional Medicare pays pre-set amounts for specific services, regardless of the particular patient involved. Under a Medicare Advantage plan, the federal government recognizes that some individuals have health risk factors that make them likely to need additional services. Medicare reimburses more for those patients and enhances payments to the Medicare Advantage plan based on how well it meets standards for quality and member satisfaction. Medicare Advantage plans have an incentive to make sure all members get the care they need. By optimizing federal reimbursement through the Medicare Advantage plan, the State is able to achieve savings while maintaining the same level of covered services for its retirees.
Medicare Advantage: Be sure your doctor accepts Medicare and is willing to bill UnitedHealthcare. If your provider is unsure, contact UnitedHealthcare and our network team will reach out to the provider. If they do not accept Medicare you will be responsible for the entire bill. If they are not willing to bill UnitedHealthcare but do accept Medicare, you will be responsible for payment up to the Medicare allowed amounts which you can then submit to UnitedHealthcare for reimbursement. Providers who accept Medicare cannot balance bill you.
Medicare Plus: The Medicare Plus will cover you with providers who opt-out of Medicare. They may bill UHC or you may pay for services out-of-pocket and submit a request for reimbursement. UHC will reimburse the provider, or yourself, up to the maximum allowed amount for services. You may be responsible for costs exceeding the maximum allowed amount.
IYC Medicare Advantage offers the same Uniform Benefits as other carriers. Medicare Plus offers slightly different benefits. See your Health Benefits Decision Guide, pages 8-10, for a comparison of benefits between these plans. There is a $0 cost for most services. You will have copays for prescription drugs. You can find electronic copies at etf.wi.gov.
You can use any medical supply company as long as they accept Medicare and will bill the plan. If you change suppliers any rental period would start over.
IYC Medicare Advantage: Yes, you will have the same Uniform Benefits as required by ETF.
Medicare Plus: The Medicare Plus plan covers what Medicare covers. There are some additional benefits the Medicare Plus plan will provide extra coverage for. Please see your Certificate of Coverage or call UHC member services at the phone number at the back of your ID card to review benefits.
IYC Medicare Advantage: UnitedHealthcare will cover all of what Medicare covers as well as additional benefits approved and required by ETF (Uniform Benefits).
Medicare Plus: The Medicare Plus plan covers what Medicare covers. There are some additional benefits the Medicare Plus plan will provide extra coverage for. Please see your Certificate of Coverage or call UHC member services at the phone number at the back of your ID card to review benefits.
Providers in our network have been credentialed and have a signed contract with UnitedHealthcare. They will bill UnitedHealthcare for your claims. UnitedHealthcare can help you find the in-network providers that are accepting new patients.
People are reluctant to make changes. Some individuals may not carefully review their benefits material and if they like their current coverage, they may not bother to make the change.
The Medicare Advantage plan may not be for people who are looking for a Medicare Supplement plans. The Medicare Advantage plan is a replacement plan that pays primary over Medicare.
Medicare Plus is a supplemental plan and the Medicare Advantage plan is a replacement plan. Medicare Plus pays secondary to Medicare and Medicare Advantage pays primary over Medicare. There are some benefit differences due to the plan types. If you have a specific benefit you'd like to compare coverage for, please contact our customer service center at 1-844-876-6175 for more information.
Please see pages 8-10 of the ETF Decision Guide for a side-by-side comparison of the Medicare Plus plan and the Medicare Advantage plan.
Through the Renew Active program, you are able to nominate a fitness facility if they are not part of Renew Active. Our team will reach out to the fitness facility to see if they are interested in joining Renew Active.
You can access the Renew Active portal through your UHC member portal. The member portal will show what your activation code is so you can access your Renew Active benefits. You can also contact our customer service team for assistance.
Yes, you can change health insurances every year through ETF's Open Enrollment.
UHC receives some funding from CMS to fund the plan based on the STAR system rating. The Medicare Plus plans offer extra programs and is secondary to Medicare whereas the Medicare Advantage plan is a replacement plan and pays primary to Medicare.