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UnitedHealthcare Community Plan
UnitedHealthcare Community Plan

UnitedHealthcare Community Plan

Frequently Asked Questions

What is a Preferred Drug List?
A Preferred Drug List (PDL) helps your doctor choose drugs to prescribe for you.  If a drug has a generic form, this is what UnitedHealthcare Community Plan will cover. In some cases, you may be able to get drugs that are not on our list if your doctor asks for prior authorization.
What is Prior Authorization?

If your doctor wants you to have a drug that is not on our list, your doctor can request it. Our pharmacy staff looks over the request within 24 hours and makes a decision.
•    If you need drugs right away, the pharmacist can fill a one-time, five-day supply of the druga not on our Preferred Drug List.
•    If you take the drug on an ongoing basis, the pharmacist can fill a 15-day supply.  The pharmacist will have to call UnitedHealthcare Community Plan's pharmacy department for approval.

What is HEALTHCHEK (Well Child Exams)?

Healthchek is Ohio’s early and periodic screening, diagnostic, and treatment (EPSDT) benefit.  Healthchek covers medical exams, immunizations (shots), health education, and laboratory tests for everyone eligible for Medicaid under the age of 21 years.  These exams are important to make sure that young adults are healthy and are developing physically and mentally.  Members under the age of 21 years should have at least one exam per year. 

Healthchek also covers complete medical, vision, dental, hearing, nutritional, developmental, and mental health exams, in addition to other care to treat physical, mental, or other problems or conditions found by an exam.  Healthchek covers tests and treatment services that may not be covered for people over age 20; some of the tests and treatment services may require prior authorization.

Healthchek services are available at no cost to members and include:

  • Preventive check-ups for young adults under the age of 21.   
  • Healthchek screenings:
    • Complete medical exams (with a review of physical and mental health development)
    • Vision exams
    • Dental exams
    • Hearing exams
    • Nutrition checks
    • Developmental exams
  • Laboratory tests for certain ages
  • Immunizations
  • Medically necessary follow up care to treat physical, mental, or other health problems or issues found during a screening.  This could include, but is not limited to, services such as:
    • Visits with a primary care provider, specialist, dentist, optometrist and other UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) providers to diagnose and treat problems or issues
    • In-patient or outpatient hospital care
    • Clinic visits
    • Prescription drugs
    • Laboratory tests
    • Health education 

Additionally, care management services are available to all members.  Please see page 16 of the Member Handbook (Coming Soon) to learn more about the care management services offered by our plan.

How Often Can I Get My Prescriptions Refilled?
You may get up to a one month supply of your medications.  Most drug orders may be refilled when most (85%) of it has been used.  For example, if your doctor prescribes you one pill a day, you would be able to get your refill every fourth week.  The pharmacy will not be able to refill a prescription earlier.  Some drugs may be limited to the amount that can be prescribed in a month.
What If I Am Already On A Medication Before I Become A Member Of UnitedHealthcare Community Plan?

In some cases, you may be able to get drugs that are not on our list if you are already taking the medication or if your doctor asks for prior authorization.  Call our Member services or look at the View Drug List on this website to see if your drugs need approval. In some cases, you may be able to get drugs that are not on our list if your doctor asks for prior authorization.

Can I Get Over-The Counter (OTC) Medication?
UnitedHealthcare Community Plan covers some OTC drugs with a prescription.  The updated OTC list can be found within our Preferred drug List (PDL) under Find A Drug on this website.  You can also call Member services with questions.  These are limited to generic drugs when available.
I Could Not Get My Prescription Filled, But It Is On The Preferred Drug List. Why?

There are a few reasons this could happen.

1. Some covered drugs need prior authorization.
2. Some drugs are called Step Therapy medications. That means you need to try other drugs before this one. These are covered only after other first-line drugs have been tried and failed.
3. Some drugs may be limited to the amount a person can be prescribed in one month.
4. Sometimes, a different strength or type of medicine is covered, such as tablets or liquid.

If you need other drugs, your doctor must get Prior Authorization from UnitedHealthcare Community Plan. Your doctor has to state how long you have been taking the drug and what other drugs you have tried.

What is Medicaid?
Medicaid is a program for people with low income who meet certain eligibility requirements and programs can vary from state-to-state.
What is Medicare?
Medicare is a federal health insurance program for people who are age 65 or older, disabled persons, or those with end-stage kidney disease. Medicare eligibility is not based on income, and basic coverage is the same in each state.
How do I apply for Medicaid?

When you apply for Medicaid, you must fill out an application form. You will also need to have various documents. You can get an application for Medicaid by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680 (TTY: 1-800-292-3572), your local County Department of Job and Family Services office, or click here.

How Do I Know if I Can Enroll With UnitedHealthcare Community Plan?

- UnitedHealthcare Community Plan is a MCP that certain Ohio Medicaid consumers who are aged, blind or disabled (ABD) or meet certain financial requirements can choose to join. Joining a MCP will not cause you to lose your Medicaid, WIC (Women, Infants and Children) or other public assistance benefits. Joining UnitedHealthcare Community Plan is voluntary. It is your choice.
- You also must live in a county that has UnitedHealthcare Community Plan.

Exclusions – Individuals that are not permitted to join a MCP

Individuals are not permitted to join a MCP if they are:

  • Children under twenty-one years of age;
  • Dually eligible under both the Medicaid and Medicare programs;
  • Institutionalized;
  • Eligible for Medicaid by spending down their income or resources to a level that meets the Medicaid program's financial eligibility requirements; or
  • Receiving Medicaid Waiver services.
  • Additionally, if anyone is a member of a federally recognized Indian tribe they have the option to not be a member of a managed care plan.
  • If you believe that you meet any of the above criteria and should not be a member of a managed care plan, or are a member of a federally recognized Indian tribe and do not want to be a member, you must call the Ohio Department of Job and Family Services (ODJFS) Managed Care Enrollment Center at 1-800-605-3040 (TTY 1-800-292-3572).
How Do I Enroll with UnitedHealthcare Community Plan?

If you are eligible for Medicaid and would like to enroll with UnitedHealthcare Community Plan, please call the Managed Care Enrollment Center at 1-800-605-3040 (TTY: 1-800-292-3572).

How do I choose a PCP?
Your PCP is your personal doctor. You may choose any individual physician, physician group practice, advanced practice nurse or advanced practice nurse group practice trained in pediatrics, family medicine (general practice), or internal medicine. If you are pregnant, you can choose a PCP trained in obstetrics/gynecology (OB/GYN). Plan Providers are listed in the provider directory or you may call Member Services for assistance in finding a plan provider.
How can I switch to another PCP?
Member Services will help make sure that the PCP you want to switch to is a participating provider with UnitedHealthcare Community Plan. They will also check to be sure the PCP you want to switch to is accepting new patients. Members can change their PCP monthly. If you change during your first month of membership, you PCP change will be effective immediately. After your first month of membership, your PCP change will take effect the first day of the next month. We will send you a new ID card with your new PCP listed. We will also let you know when you can start seeing your new PCP.
What if my doctor or other provider leaves your plan?
Sometimes a PCP, specialist, clinic, hospital or other plan provider you are using might leave the Plan. If this happens, you will have to switch to another provider who is part of our Plan. If your PCP leaves our Plan, we will let you know and help you choose another PCP so that you can keep getting covered services.
How is a "medical emergency" defined?
A "medical emergency" is a medical problem that you think is so serious that a doctor must treat it right away. Some examples of a medical emergency are severe chest pain, possible stroke, heart attack, or a miscarriage/pregnancy with vaginal bleeding.
What should I do if I have a medical emergency?

If you have a medical emergency:

  • Get medical help as quickly as possible. Go to the nearest hospital emergency room or other appropriate setting. Be sure to tell them you are a member of UnitedHealthcare Community Plan and show them your ID card if you are able.
  • If you need emergency transportation, call 911 or your local emergency service.
  • Make sure that your PCP knows about your emergency, because your PCP needs to be involved in following up on your emergency care. You or someone else should call to tell your PCP about your emergency care as soon as possible.
How to get urgently needed care?
If you need urgent care, you can visit an urgent care center. You do not need to get an OK before you do. If you need help locating an urgent care center near you, Member Services can help. If you do not know if you need to visit an urgent care center, you can call your PCP or our 24/7 NurseLine services.
What if I use non-plan providers to receive services that are "covered"?

It is important to remember that you must receive services covered by UnitedHealthcare Community Plan from UnitedHealthcare Community Plan facilities and/or providers. The only time you can see providers that are not on UnitedHealthcare Community Plan's panel is for:

  • Emergency services
  • Federally Qualified Health Centers / Rural Health Clinics
  • Qualified Family Planning Providers
  • Community Mental Health Centers
  • Ohio Department of Alcohol and Drug Addiction Services facilities that are Medicaid providers
  • An out of panel provider that UnitedHealthcare Community Plan has approved you to see
  • Pharmacies for prescription drugs and some prescription medical supplies that are covered by Ohio Medicaid


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UnitedHealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the state Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Nurseline Disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your doctor's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time.

UnitedHealthcare Connected™ for MyCare Ohio (Medicare-Medicaid Plan)

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) information, please contact our Member Services at 1-877-542-9236 (TTY 711) from 7 a.m. to 8 p.m. Monday through Friday (voice mail available 24 hours a day/7 days a week) for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare® Connected™ de MyCare Ohio (plan Medicare-Medicaid), comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al 1-877-542-9236 (TTY 711) de lunes a viernes de 7 a.m. a 8 p.m. (correo de voz disponible las 24 horas del día, los 7 días de la semana).

UnitedHealthcare Connected™ (Medicare-Medicaid Plan)

UnitedHealthcare Connected (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected Benefit Disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits and/or copayments may change on January 1 of each year.

UnitedHealthcare Senior Care Options (HMO SNP) Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

Availability of Non-English Disclaimer

This information is available for free in other languages. Please call our customer service number at 1-800-905-8671, TTY 711, 8 a.m. - 8 p.m. local time, 7 days a week.

Esta información está disponible sin costo en otros idiomas. Comuníquese con nuestro Servicio al Cliente al número 1-800-905-8671, TTY 711, de 8 a.m. – 8 p.m. hora local, los 7 días de la semana.

Star Ratings Disclaimer

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.


The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary.


UnitedHealthcare Connected has a Model of Care approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) through 2016 based on a review of UnitedHealthcare Connected’s Model of Care.