Frequently Asked Questions

Page Content Footer

Click on a question to reveal the answer.

Q.
What Is Medicare?
A.

Medicare is a national health insurance program run by the federal government. It’s for people age 65 and older, and also some people under age 65 with certain disabilities.

Q.
What’s the difference between Medicaid and Medicare?
A.

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is funded jointly by states and the federal government. Medicare is a federal program. It provides coverage for people age 65 and older, and also some people under age 65 who qualify due to a disability.

Q.
What’s a Medicare Advantage Plan?
A.

Medicare Advantage Plans (also known as Medicare Part C) offer an alternative to Original Medicare (also known as Medicare Parts A and B). Medicare Advantage (MA) Plans replace your coverage under Parts A and B, and sometimes include additional coverage. They often (but not always) include a specific network of doctors and health care providers you can use to get care, sometimes at lower costs.

Q.
What’s a dual special needs plan?
A.

Dual special needs plans (also called "dual" or "Medicare-Medicare" plans) are for people who qualify for both Medicare and Medicaid. Dual plans combine Medicaid and Medicare into one simple plan. They cover doctor visits, hospital stays and prescription drugs. For people who qualify, these dual plans may offer more health benefits than with Original Medicare and a separate Part D plan.

Dual plans:

  • Are designed for people who may need extra help because of disabilities, age and/or health conditions.
  • Provide more benefits than Original Medicare.
  • Are offered by private insurance companies like UnitedHealthcare.
  • Come with no additional costs. (Even if you do have a premium — that’s the amount you pay for insurance — you may qualify for low-income subsidies to help with the cost.)
Q.
What are the advantages of a dual special needs plan?
A.

Dual health insurance plans offer benefits and services not typically available through Medicare or Medicaid. With a dual plan, you’ll keep your Medicaid benefits, and you’ll get more benefits than Original Medicare at no extra cost.

UnitedHealthcare dual plans include a wide range of extra benefits and features.* Our plans may cover:

  • Routine dental care
  • Credits to buy hundreds of health products
  • Eye exams, plus credit for eyewear
  • Hearing exams, plus credit for hearing devices
  • And more

Dual plans also include care coordination. That’s a big help — especially for people who have complex medical needs. It makes it easier to manage your doctors, specialists and care services.

* Please note that the dual plans UnitedHealthcare offers, and the specific benefits they include, can change depending on where you live. For details about the dual plans available in your area, please use the search feature on our home page at UHCCommunityPlan.com.

 

Q.
Can you have Medicare and Medicaid at the same time?
A.

Yes. Some people qualify for both Medicare and Medicaid. These people qualify for Medicare due to age (by being age 65 or older) or because they have a disability. They also qualify for Medicaid because they meet the Medicaid requirements in their state. People who are eligible for both Medicare and Medicaid are “dual eligible.”

Q.
What does dual eligible mean?
A.

“Dual eligible” describes people who qualify for both Medicare and Medicaid at the same time. These people are eligible for both programs, so they’re “dual eligible.”

Q.
Can I have Medicaid and private insurance?
A.

Medicaid is a health care program that’s managed at the state level by each state government. However, state governments do not actually provide health insurance. State governments contract with private insurance companies like UnitedHealthcare to provide health coverage for beneficiaries of Medicaid and other government health care programs. Our government-sponsored health plans operate under the name UnitedHealthcare Community Plan.

Q.
Is UnitedHealthcare part of Medicare?
A.

UnitedHealthcare health plans are offered by United Healthcare Insurance Company. We (and other private insurance companies) work with federal and state agencies to provide government-sponsored health insurance. We are not part of Medicare. We work with the Centers for Medicare & Medicaid Services (CMS) and many state governments to provide health coverage for Medicare and Medicaid recipients.

Q.
How can I enroll in Medicaid?
A.

You’ll need to apply through the state agency that manages the Medicaid program in your state. For questions, or to see what health plans UnitedHealthcare Community Plan offers in your area, please use the search feature on our home page at UHCCommunityPlan.com.

Q.
What do I need to apply for Medicaid?
A.

When you apply for Medicaid, you’ll need to fill out an application form. Different states have different requirements for Medicaid. You’ll likely need to have various documents, such as:

Personal information

  • Information about household members (name, date of birth and Social Security number)
  • Proof of citizenship

Financial information

  • Rent or mortgage information
  • Expenses (utilities, daycare, etc.)
  • Vehicle information
  • Bank statements
  • Income (pay stubs)

Medical information

  • Proof of disability or medical records showing a lasting medical condition
  • Recent medical bills
Q.
Who can qualify for Medicaid?
A.

In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states, Medicaid covers all low-income adults below a certain income level.

Q.
What are the eligibility requirements for Medicaid?
A.

The exact requirements to qualify for Medicaid depend on where you live. To find out if you're eligible for Medicaid in your state, visit the website for Medicaid in your state. Then check the eligibility requirements.

You’ll find a link to the website for your state Medicaid agency on the “Plan Details” page for each health plan UnitedHealthcare Community Plan offers. To see the plans available in your area, please use the search feature on our home page at UHCCommunityPlan.com.

Q.
How does Medicare and Medicaid work together?
A.

The Affordable Care Act created a new office within the Centers for Medicare & Medicaid Services (CMS). The Medicare-Medicaid Coordination Office makes sure people who are dually enrolled in both Medicare and Medicaid have full access to seamless, high quality health care. The goal is to make the two programs work together more effectively to improve care and lower costs.

Medicaid programs can help Medicare by paying certain Medicare costs. And by covering benefits not offered by Medicare, such as hearing, transportation, vision, dental and long-term care.

Q.
How do you qualify for both Medicare and Medicaid?
A.

Medicare and Medicaid are two separate programs that have different eligibility requirements.

To qualify for Medicare, you need to be:

  • At least 65 years old, or under 65 and qualify on the basis of disability or other special situations.
    AND
  • A U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years in a row.

To qualify for state Medicaid benefits, you need to be.

  • Under age 65 and meet the requirements for low-income families, pregnant women and children, individuals receiving Supplemental Security Income (SSI), disability or other special situation.
  • At least 65 years old and you also:
    • Receive Extra Help or assistance from your state.
    • Are blind or have a disability, but do not need long-term care.

As part of the Affordable Care Act, most states chose to expand Medicaid coverage to include all low-income adults under age 65. Other states may choose to do so at any time. Many people are surprised to find out they qualify. That’s why it’s always good to check.

To see if you're eligible for Medicaid in your state, visit the website for Medicaid in your state. Then check the eligibility requirements.

Q.
What are the eligibility requirements for dual special needs plans?
A.

1. Do you get state Medicaid benefits? (If so, you’ll have a state Medicaid card.)

You are under age 65 and meet the requirements for low-income families, pregnant women and children, individuals receiving Supplemental Security Income (SSI), disability or other special situation.

  • You are at least 65 years old and you also:
    • Receive Extra Help or assistance from your state.
    • Are blind or have a disability, but do not need long-term care.

2. Do you have Medicare Parts A and B?

  • You’re at least 65 years old, or you’re under 65 and qualify on the basis of disability or other special situations.
    AND
  • You’re a U.S. citizen or a legal resident who has lived in the U.S. for at least 5 years in a row.

3. Do you live in an area where dual plans are available?

A UnitedHealthcare licensed sales agent can tell you if you live in our service area. Or, to see the plans available in your area, please use the search feature on our home page at UHCCommunityPlan.com.

4. Do you meet the health requirements?

Most likely, you won’t be able to qualify for a dual plan if you have end-stage kidney failure, also called end‑stage renal disease (ESRD). If that’s the case, please talk with a UnitedHealthcare licensed sales agent to discuss your specific situation.

 

Q.
When can you apply for a dual special needs plan?
A.

Effective January 1, 2019 DSNP's will no longer have unlimited special enrollment period. Enrollment changes will be effective the first day of the next month.

NOTE: It’s important to remember that you must renew your enrollment in a dual plan every year.

Q.
When you have a UnitedHealthcare dual plan, do you need to get a referral to see a specialist?
A.

No. Referrals are not needed to get care from any in-network doctors, hospitals or clinics.

Q.
What happens if I lose my Medicaid eligibility?
A.

If you’re enrolled in a UnitedHealthcare dual plan and you lose your Medicaid eligibility, we’ll put you on hold for 6 months. During this time, you’ll have to pay the Medicare cost-sharing portion such as copayments, coinsurance, deductibles and premiums. If you don’t regain your Medicaid eligibility at the end of the 6 months, you’ll be unenrolled from our dual plan.

But remember, you can enroll in a dual plan at any time. If you get your Medicaid coverage back, just talk with a UnitedHealthcare licensed sales agent to re-enroll in a dual plan. 

Q.
What standard benefits are typically covered by UnitedHealthcare dual plans?
A.

Our dual plans typically cover preventive care and routine services at no extra cost to you. We also offer help with coordinating Medicaid benefits. Other standard benefits that are usually covered by our dual plans include:

  • Dental
  • Vision
  • Hearing
  • Transportation assistance
  • 24-hour NurseLine™
  • And many other benefits and features

Questions

Call Us
1-800-905-8671
TTY: 711

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