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UnitedHealthcare Community Plan
UnitedHealthcare Community Plan

UnitedHealthcare Dual Complete® (HMO SNP)
H5253-059

Find A Provider

Search our directory of network doctors, specialists, facilities and more: 

Search for a provider

Download the General Provider and Facilities Directory (PDF 14.74 MB)

Find A Drug

This search option is only available for desktop users. Note that you can download a list of covered drugs below.

Pharmacy Prior Authorization Request

Click here to submit a Pharmacy Prior Authorization Request to OptumRx.


Appeal a Coverage Decision

If we make a coverage decision and you are not satisfied with this decision, you can "appeal" the decision. An appeal is a formal way of asking us to review and change a coverage decision we have made.

Click here to send an email with your appeal request.

Click here to find and download the Evidence of Coverage for this plan and review the grievance and appeals section.

Drug Coverage Determination Request Form (PDF 61.1 KB)

Pharmacy Direct Member Reimbursement Request

Download a MAPD Prescription Reimbursement Request Form (PDF 188.1 KB) from OptumRx. 

Prescription Drug Transition Process

What to do if your current prescription drugs are not on the formulary or are limited on the formulary.

New members
As a new member of an UnitedHealthcare Dual complete plan, insured through UnitedHealthcare, you may currently be taking drugs that are not on the UnitedHealthcare® formulary (drug list), or they are on the formulary but your ability to get them is limited.

In instances like these, start by talking with your doctor about appropriate alternative medications available on the formulary. If no appropriate alternatives can be found, you or your doctor can request a formulary exception. If the exception is approved, you will be able to obtain the drug for a specified period of time. While you and your doctor are determining your course of action, you may be eligible to receive an initial 31-day transition supply (unless your prescription is written for fewer days) of the drug anytime during the first 90 days you are a plan member.

For each of your drugs that is not on the formulary or if your ability to get your drugs is limited, UnitedHealthcare will cover a 31-day supply (unless your prescription is for fewer days) when you go to a network pharmacy. If the prescription is written for less than 31 days, multiple fills are allowed to provide up to a total of 31 days of drugs. After your first 31-day transition supply, these drugs may not continue to be covered. Talk with your doctor about appropriate alternative medications. If there are none on the formulary, you or your doctor can request a formulary exception.

If you live in a long-term care facility, UnitedHealthcare will cover a temporary 31-day transition supply (unless your prescription is for fewer days). UnitedHealthcare will cover more than one refill of these drugs for the first 90 days for plan members, up to a 93-day supply. If you need a drug that is not on the formulary or your ability to get your drugs is limited, but you are past the first 90 days of plan membership, the transition program will cover a 31-day emergency supply of that drug (unless your prescription is for fewer days) while you pursue a formulary exception.

You may face unplanned transitions after the first 90 days of plan enrollment, such as hospital discharges or level of care changes (i.e., changing a long-term care facility or in the week before or after a long-term care discharge, end of skilled nursing facility stay and reverting to Medicare Part D coverage or when taken off of hospice care). If you are prescribed a drug that is not on the formulary or your ability to get your drugs is limited, you are required to use the plan's exception process. You can request a one-time emergency supply of up to 31 days to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.

Continuing members
As a continuing member in the plan, you receive an Annual Notice of Changes (ANOC). You may notice that a formulary medication you are currently taking is either not on the upcoming year's formulary or its cost sharing or coverage is limited in the upcoming year.

If you have any questions about this transition policy or need help asking for a formulary exception, a UnitedHealthcare representative can help.

Related Information
Medicare Part D Coverage Determination Request Form - (for use by members and providers)
The Coverage Determination Request Form may be found under Appeal a Coverage Decision section on this page.

Medication Therapy Management Program

UnitedHealthcare’s Medication Therapy Management program was developed by a team of pharmacists and doctors to help eligible members make better use of their coverage and to improve their understanding and use of medications.  It also helps protect members from the possible risks of drug side effects and from potentially harmful drug combinations.

This program is not a plan benefit and is available at no additional cost to you. You will be automatically enrolled in the Medication Therapy Management Program if you:

  • take eight (8) or more chronic Part D medications, and
  • have three (3) or more long-term health conditions, and
  • might spend more than $3,919 a year on covered Part D medications

Below is a list of health conditions that may make you eligible for the Medication Therapy Management program. You need to have three or more of these conditions to qualify for this program.

  • Diabetes
  • Hypertension (High Blood Pressure)
  • Heart Failure
  • High Cholesterol
  • Rheumatoid Arthritis

UnitedHealthcare’s Medication Therapy Management program offers a Comprehensive Medication Review (CMR) for all eligible members over the phone. A pharmacist will review the member’s medication history, including prescription and over-the-counter medications, and identify any issues.  Upon completion of the medication review, the member is mailed a Medication Action Plan that summarizes any clinical concerns identified and a Personal Medication List of their medication history.  In addition, the member’s doctor is contacted and this information is provided to them. 

To help you track your medications, you can also download a blank Personal Medication List (PDF 308.21 KB) for your personal use.

Members may also receive helpful information in the mail. This can include additional information about their medications and suggestions from our pharmacists about how to make the most of your medications and benefits. This information can be helpful when meeting with your doctor or pharmacist.

For more information on UnitedHealthcare’s Medication Therapy Management program, please talk to a UnitedHealthcare representative (the phone number is on the back of your plan member ID card).

Please note that these programs may have limited eligibility criteria and are not considered a benefit.

Find A Dentist

Dental Provider Search

Find a dentist in your area. Click on "Search for a Dentist" below to begin your search. A new window will appear for myuhc.com. Select "Locate Dentist", then "NATIONAL MEDICARE NETWORK" from the list of dental plans.

Search for a Dentist

Find A Pharmacy

Search for a network pharmacy below.

You may also go to OptumRx to order and manage your prescription drugs online.

Questions?

Ready to Enroll?

Call Us
1-866-790-9381
TTY: 711

8 a.m. – 8 p.m. local time,
7 days a week.

Already A Member?
1-800-643-4845
TTY: 711

8 a.m. – 8 p.m. local time,
7 days a week.

Enrollment Tools

Member Information

Summary of Benefits

More Resources

Member Page

View more news, updates and resources for members.

Summary of Benefits
Disclaimer Information

Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

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.

Formularies

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

NCQA

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.