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UnitedHealthcare Community Plan

Medicaid

The New York State Medicaid Managed Care Plan is offered through UnitedHealthcare Community Plan. It’s for New York State residents who meet the income or disability requirements.

To find out if UnitedHealthcare Community Plan is offered in your county, please call 1-888-617-8979.  A representative will contact you to schedule an appointment to help you apply.

More information on eligibility and enrollment can be found on the New York State of Health website.

For more information about Child Health Plus or Medicaid, call New York Health Options at 1-800-541-2831.  

To learn more about applying for health insurance through NY State of Health, The Official Health Plan Marketplace, visit www.nystateofhealth.ny.gov or call 1-855-355-5777.

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Benefits & Features

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Well and Sick Care

Get the care you need to stay healthy — or to get better if you are injured or sick. That includes:

  • Choice of Doctor. Use "Doctor Lookup" to see if your doctor is in our network or to find a new one.
  • Dental. We cover cleanings, checkups and dental work.
  • Well Visits. Annual checkups can help keep you healthy.

Make sure your sight, teeth, speech and hearing are at their best. Benefits include:

  • Vision. Covers eye exams and glasses.
  • Dental. We cover cleanings, checkups and dental work.
  • Hearing. Screenings and therapies, if needed, are provided.

Get the medical care and equipment you need to live at home. Benefits include:

  • Care Coordinator. Someone to get you the services you need to recover safely.
  • Personal Care. Services to help you heal after illness or injury.
  • Home Meal Delivery. If you can’t safely make meals, we'll provide them.
  • Equipment and Supplies. In-home medical and safety equipment are covered.
  • Nurse Visits. Care after surgery or illness to recover at home.

Nothing is more important than the health and well-being of you and your baby. That's why our plan benefits include:

  • Choice of Doctor. Find an OB-GYN you trust in our network.
  • Prenatal Visits. Care for you before your baby is born.
  • Healthy First Steps®. Get extra support to help you and your baby stay healthy.
  • Choice of Birth Center. Pick from hospitals across New York.

If you have special health care needs, you can count on us. Our plan will provide the extra care and services needed. Benefits include:

  • Mental Health. Counseling and other treatments are covered.
  • Case Management. If you qualify, get personal help managing health conditions.
  • Asthma and COPD Care. Exams, testing and supplies are covered.

Adult Day Care

Companionship is important. Adult day care provides care and companionship for seniors who need extra help during the day.

Caregivers also benefit, knowing their loved one is well cared for and safe during the day.

Adult day care can provide:

  • Social connections and friendship.
  • Bathing and personal care.
  • Meals.

Asthma and COPD Care

Individual care to help control asthma, allergies or COPD symptoms.

Do you or your child have trouble managing asthma, allergies or COPD symptoms? A nurse who specializes in breathing issues can really help. You'll get a customized treatment plan and medicine to:

  • Manage flare-ups.
  • Reduce symptoms.
  • Let you or your child stay active.

Case Management

Do you or your child have a serious health problem or a high-risk pregnancy? If so, and you or your child qualifies, we offer case managers that can:

  • Explain medical terms in plain language.
  • Coordinate your doctor appointments.
  • Provide your care team with your medical records.

Your case manager will stay with you or your child throughout the medical journey. He or she will:

  • Think beyond your medical needs.
  • Make sure you have support at home.

So you or your child can focus on getting better.

Choice of Birth Center

Where you have your baby is an important choice. That's why you can pick from hundreds of hospitals across New York.

We encourage you to tour the hospital's birthing center. This way you will be familiar with it. And you'll be more relaxed when you have your baby.

Choice of Doctor

You get a primary care physician (PCP), who is your main doctor. Use the Doctor Lookup tool to see if your doctor is in our network.

If you don't have a doctor or if your doctor is not in our network, we can help you find a new one close to you. 

Your PCP is your main doctor for:

  • Preventive care.
  • Treatment if you are sick or injured.
  • Referrals to specialists for certain conditions.

Dental Care

Checkups and emergency care are covered.

Exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, that’s covered as well.

Diabetic Supplies

If you have diabetes, you may need insulin, needles, wipes and glucose strips. We cover all that and more.

Our plan also steps up with services to help you manage your diabetes, including:

  • Classes on keeping diabetes in control.
  • Coordinating doctor care.
  • Nutrition and diet.

Durable Medical Equipment

Your health and safety at home are important.

Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:

  • Diabetic supplies.
  • Hospital beds.
  • Wheelchairs or walkers.

Emergency Response System

If you are at risk for a fall or sudden illness, an emergency call system can really help. It sends an urgent request for someone to check on you and help you.

Grief Support

A loss can take many different forms. And you may get lots of suggestions on what to do. Grieving is part of the healing process.

If a recent loss has made you sad or unhappy, help is available. Our plan offers counseling and support during the grieving process. Our team will work with you to find a counselor or program to help you adjust to your loss.

Healthy First Steps®

The Healthy First Steps team is here for you. Our program will help you take the right steps to keep you and your baby healthy. 

We will help you:

  • Choose a pregnancy provider and a pediatrician (child’s doctor).
  • Schedule visits and exams and arrange rides to your visits.
  • Get supplies, including breast pumps for nursing moms.
  • Connect with community resources such as Women, Infants and Children (WIC) services.

Hearing Care

Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing.

Our plan covers:

  • Exams, therapy and tests.
  • Hearing aids.

Home Meal Delivery

Taking care of the basics, like cooking, can be hard to do yourself after an illness or sickness.

If you are receiving personal care services, you may need extra help to get through the tough times. We'll step in to bring nutritious meals to you. You can get up to 10 meals delivered each year.

In-Home Care

After surgery or a serious illness you may need extra help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing. With approval, our plan covers:

  • Medical equipment like hospital beds, walkers or wheelchairs.
  • Disposable medical supplies.
  • In-home medical visit.

Hospitalization

This plan pays for all expenses related to a hospital stay, so you can rest and heal.

Hospitalization coverage includes:

  • Nursing care.
  • Room and board.
  • Supplies and equipment.
  • Treatment and therapies.
  • Diagnostic tests and exams.

And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

Member Services

Sometimes you might need a little help understanding your health care options. With us, you have someone you can call Monday – Friday 8 a.m. – 6 p.m. EST. We'll answer your questions simply and completely.

We can also help you find:

  • Home care providers.
  • Dentists and vision providers.
  • Adult day health centers.

Mental Health/Substance Use Disorder

Addiction can happen to anyone, any family, at any time according to the New York State Office of Alcoholism and Substance Abuse Services (OASAS).

UnitedHealthcare is here to assist you in all your healthcare needs. We have trained professionals who are experienced in understanding Substance Use Disorder and able to help you get treatment or give you information that will help you make decisions about your healthcare. You or your provider can call Optum Behavioral Health anytime for help at 1-844-206-1399.

Covered services include:

  • All inpatient mental health and substance use disorder services (including alcohol and substance use disorder).
  • Most outpatient mental health services (contact plan for specifics).
  • Medicaid recipients who receive SSI or who are certified blind or disabled get mental health and substance use disorder services from any Medicaid provider by using their Medicaid Benefit Card.
  • Detoxification services are covered by UnitedHealthcare Community Plan as a benefit.

No Copays

You will not have a copayment for care and services covered by our plan, other than for prescription drugs.

That means you will pay nothing for covered services, including:

  • Preventive care.
  • Annual checkups.
  • Routine dental or vision care.

You pay nothing for your child's care and services covered by our plan.

Nurse Visit

Sometimes you may need continued care after you leave the hospital or urgent care.

If your health is at risk after a serious illness, surgery or injury, a nurse will visit you at home to:

  • Provide medical care for you.
  • Answer your questions and concerns.

Nutrition Coaching

Healthy eating goes a long way to helping you stay at your best.

A nutritionist can meet with you to review your eating habits and food choices.

You'll come away with new ideas for:

  • Making good choices for quick meals and snacks.
  • Preparing healthy meals on a budget.

Outpatient Services

Knowing what's wrong and finding it early can make all the difference.

Our plan covers:

  • Labs and testing.
  • X-rays, scans and other imaging.

We'll help you get the information needed to help improve your health or be your best.

Palliative Care Services

Our plan offers the following palliative care services:

  • Pain Management
  • Bereavement
  • Massage Therapy
  • Expressive Therapy

Personal Care

Sometimes the basics are hard to do yourself after an illness or injury.

If needed, we provide someone to help with:

  • Dressing.
  • Bathing.
  • Feeding.

Prenatal Visits

A pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN.

All of your recommended prenatal clinical visits and tests are covered.

At these visits, the clinic will:

  • Make sure you and your baby are healthy.
  • Explain what to expect at each stage of your pregnancy.
  • Answer your questions.

Quitting Tobacco

You know the bad health effects of smoking.

You know you need to quit. We support you while you quit with the help of coaches and supplies. The only thing you won't get from us is a lecture.

Residential Care

After a serious illness, surgery or injury, you may need extra nursing and therapy.

If needed, our plan covers short stays in a rehabilitation center where you can heal. Included are:

  • Nursing home services.
  • 24-hour nursing care.
  • Help with activities of daily living.
  • Physical, occupational and speech therapy.

Respite Care

Do you have family members or friends who care for you at home? If so, we want to support their hard work too. That’s why we provide respite care to give your caregivers a rest. Respite care offers caregivers time away from their loved one who is ill or has special care needs.

Shots and Immunizations

Routine shots help keep you healthy.

So, our plan covers:

  • Recommended shots and vaccines.
  • Diagnostic tests and exams.

Vision Care

See life more clearly with routine eye exams and glasses, if needed.

We also include:

  • Prescription lenses.
  • Medicaid approved frames.
  • New eyeglasses every two years.

This benefit is offered by March Vision Care.

Well Visits

Well visits with your doctor can help you stay healthy. These visits can catch health problems early, so they can be treated.

Preventive services include:

  • Checkups for adults and children.
  • Well-baby care.
  • Care for women expecting a baby.
  • Routine shots and tests.
  • Mammograms.

There are no copayments for preventive care.

Member Resources

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UnitedHealthcare Community Plan

Disclaimer Information
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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. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Nurse Hotline 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. Nurse Hotline not for use in emergencies, for informational purposes only.

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. 

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® for One Care (Medicare-Medicaid Plan)

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

UnitedHealthcare Connected® general 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. 

UnitedHealthcare Senior Care Options (HMO SNP) Plan

UnitedHealthcare Senior Care Options (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 and does not have any other comprehensive health Insurance, except 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 Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5 Star rating applies to plan year 2023.

Important provider information

The Choice is Yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non- contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 TTY 711, or use your preferred relay service.

Declaration of Disaster or Emergency

If you’re affected by a disaster or emergency declaration by the President or a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non- contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.

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Last Updated: 06.01.2023 at 10:53 AM CDT

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