UnitedHealthcare Community Plan

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®

You may receive help and advice from your mom, aunts, sisters and girlfriends. Yet every pregnancy is different. This program will support you through your pregnancy.

We help you:

• Find a doctor for you and your baby.
• Learn resources for nutrition, fitness and safety.
• Get supplies, including breast pumps for nursing moms.

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.

Medicines

Our plan covers prescription drugs and refills with a small copayment. Your copay is:

• $1.00 for generic drugs.
• $3.00 for brand name drugs.

Over-the-counter medicines with a written order from your doctor are available for a copayment of $0.50 for each medicine.

And we make getting your medicine easy. You can fill your prescriptions at:

• Local pharmacies.
• Services that deliver right to your door.

Member Services

Sometimes you might need a little help understanding your health care options. With us, you have someone you can call 24/7. 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 1-888-291-2506.

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.

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.