AARP® MedicareComplete® (HMO), AARP®
MedicareComplete® Plus (HMO-POS) and AARP®
MedicareComplete® PPO Plans
Frequently Asked Questions
Beginning Jan.1, 2017, UnitedHealthcare will offer new AARP® MedicareComplete® plans in the
following Florida counties: Citrus, De Soto, Gadsden, Gilchrist, Hardee, Highlands, Holmes, Jackson,
Levy, Nassau, Suwannee, and Washington. Here are answers to some frequently asked questions about
the plans, including information on the WellMed delegation.
For more information, please contact Provider Services at 877-842-3210. Thank you.
Member Eligibility
Q1.
How can care providers verify member eligibility and benefits?
A. Eligibility and benefits can be checked by calling the phone number on the back of the member’s ID card
or visit UnitedHealthcareOnline.com > Link > Eligibility & Benefits.
Q2.
How will care providers know which plan a patient is enrolled in?
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A. The front of the member’s ID card will display the AARP MedicareComplete plan name in the bottom right
corner and the contract number in the bottom left corner. UnitedHealthcare’s logo, plan group number and
name of the member’s primary care physician (PCP) will also be on the front of the card.
Referrals for Specialty Care
Q3.
Which plans require a referral for specialist services?
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A. The AARP MedicareComplete® (HMO) plan requires members to obtain referrals for most services.
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Referrals Required will be displayed on the front of the ID card. Because AARP MedicareComplete Plus
(HMO-POS) and AARP MedicareComplete PPO plans are open access plans with no referrals required, the
No Referral Required insignia will display on the back of the card.
AARP® MedicareComplete® (HMO), AARP®
MedicareComplete® Plus (HMO-POS) and AARP®
MedicareComplete® PPO Plans
Frequently Asked Questions
Q4.
How can care providers submit referrals?
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A. AARP MedicareComplete® (HMO) members are required to obtain referrals for specialty care - except
for emergent or urgent care services. The PCP can submit the referral request through Link at
UnitedHealthcareOnline.com > Link > Eligibility & Benefits. The specialist referral must be on file
prior to claim payment.
If the member has selected a WellMed-delegated PCP, referrals and claims must be submitted through
eProvider Resource Gateway (EPRG) as indicated on the back of the ID card. Please see the WellMed
delegation FAQ for more information at UnitedHealthcareOnline.com > Tools & Resources >
Products & Services > Medicare.
Q5.
How do care providers know if a member is assigned to a WellMed-delegated PCP?
A. These plan group numbers on the front of the ID card indicate WellMed delegation: 82955, 82956, 82957,
82958, 82960, 82940, 82980, 82971, 82969, 82963, 82970, 82977 and 82978.
Notifications and Prior Authorizations
Q6.
How do care providers submit a prior authorization or notification request?
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A. Prior authorization requests and notifications for AARP MedicareComplete® (HMO), AARP
®
MedicareComplete® Plus (HMO-POS) and AARP MedicareComplete® PPO members should be
submitted using the standard process at UnitedHealthcareOnline.com > Link > Eligibility & Benefits.
Prior authorization requests for members with a WellMed-delegated PCP must be submitted through
EPRG.
Network Access
Q7.
Do members have access to all UnitedHealthcare MedicareComplete in-network specialists, ancillary
providers or hospitals in the state of Florida?
A. Yes, members have access to our network of care providers and hospitals throughout Florida.
Q8.
Are members covered for services received outside of the plan network?
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A. AARP MedicareComplete® (HMO) plan members do not have out-of-network benefits. AARP
MedicareComplete® Plus (HMO-POS) members have limited out-of-network benefits when receiving
services in the plan service area from an out-of-network provider.
AARP MedicareComplete PPO Individual Plans
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Q9. Will the AARP MedicareComplete Choice® Plan 2 (Regional PPO), the AARP MedicareComplete
Choice® Essential (Regional PPO) and the AARP MedicareComplete Choice® (PPO) continue to be
offered?
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A. Yes, the individual PPO plans will continue to be offered in Florida. The AARP MedicareComplete
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Choice Plan 2 (Regional PPO) and the AARP MedicareComplete Choice Essential (Regional PPO) are
offered in all 67 counties in the state of Florida. The CMS contract number for these plans will change
from R5287 to R7444 in 2017. The group numbers will remain the same.
Q10. Are PPO members covered for services received outside of the plan network?
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A. AARP MedicareComplete PPO plan members have national out-of-network coverage.
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AARP® MedicareComplete® (HMO), AARP®
MedicareComplete® Plus (HMO-POS) and AARP®
MedicareComplete® PPO Plans
Frequently Asked Questions
AARP MedicareComplete Florida Plans
Medicare Advantage HMO Plans – Referrals Required
2017 Plan Name
CMS Contract/
Plan County
Plan Group
Number
Plan Description
H1045-028: Charlotte,
Hernando, Hillsborough, Indian
River, Lee, Manatee, Martin,
Pasco, Pinellas, Polk, Sarasota,
St. Lucie
80000 and 82958**
H1045-030: Brevard, Orange,
Osceola, Seminole
82037 and 82960**
H1045-033: Alachua, Columbia,
Gilchrist* and Suwannee*
*New for 2017
82951 and 82969**
H1045-035: Flagler, Putnam,
St. Johns
82954 and 82963**
Flat outpatient surgery copay
H1045-042*: Desoto, Hardee,
Highlands
*New for 2017
82984 and 82977**
H1045-043*: Citrus and Levy
*New for 2017
82985 and 82978**
SilverSneakers fitness and
hearing aids programs and
UnitedHealth Passport
included
AARP® MedicareComplete®
Plan 2 (HMO)
H1045-034: Collier and Lee
82953 and 82962**
AARP® MedicareComplete®
Focus (HMO)
H1045-026: Clay, Duval and
Nassau*
*New for 2017
H1045-036: Indian River,
Martin and St. Lucie
82980**
82995
AARP® MedicareComplete®
(HMO)
Individual Medicare
Advantage HMO plans with
a prescription drug benefit;
PCP selection is required
and referrals/authorizations
are required for most
services; in-network
benefits only
Transportation program
included only in the AARP®
MedicareComplete® Focus
(HMO)
82970**
** Group numbers delegated through WellMed for utilization management and claim payment
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AARP® MedicareComplete® (HMO), AARP®
MedicareComplete® Plus (HMO-POS) and AARP®
MedicareComplete® PPO Plans
Frequently Asked Questions
Medicare Advantage Open Access Plans – No Referrals Required
2017 Plan Name
AARP® MedicareComplete
Plan (HMO-POS)
*New for 2017
CMS Contract
and Plan County
Plan
Group
Number
H1045-031: Escambia, Okaloosa
and Santa Rosa
82949
H1045-032: Bay and Walton
82950
Plan Description
Individual Medicare Advantage
HMO-POS plan with a
prescription drug benefit; PCP
selection is required; flat
outpatient surgery co-pay
SilverSneakers fitness and
hearing aids program and
UnitedHealth Passport included
H1045-041*: Gadsden, Holmes,
Jackson and Washington
*New for 2017
82976
AARP® MedicareComplete
Choice® (PPO)
H2228-033: Charlotte,
Hernando, Hillsborough, Lee,
Pasco and Pinellas
81100 and
82957**
Individual Medicare Advantage
PPO plan with a prescription drug
benefit; PCP selection is required;
SilverSneakers fitness and
hearing aids programs and
UnitedHealth Passport included
AARP® MedicareComplete
Choice® Plan 2 (Regional
PPO)
+R7444-003: Members can
reside in any Florida county to
enroll
+New Contract Number for
2017
82075 and
82955**
Individual Medicare Advantage
PPO plan with a prescription drug
benefit; PCP selection is required;
hearing aids program and
UnitedHealth Passport included
AARP® MedicareComplete
Choice® Essential (Regional
PPO)
+R7444-004: Statewide:
Members can reside in any
county in Florida to enroll
+New Contract Number for
2017
82058 and
82956**
Individual Medicare Advantage
PPO plan without a prescription
drug benefit; PCP selection is
required; hearing aids program
and UnitedHealth Passport
included
** Group numbers delegated through WellMed for utilization management and claim payment
Doc#: PCA-2-002931-08102016_09082016