Medicaid: More For You In 2022

As a UnitedHealthcare STAR Medicaid member, youll get extra benefits that some plans dont offer. Not all STAR plans are the same. UnitedHealthcare Community Plan provides standard benefits under the STAR program. We also offer extra services called Value Added Services . View the list below to see what STAR includes.

• Well and sick care

See Why Texans Choose Unitedhealthcare

Whatever plan you choose, UnitedHealthcare will help you get the care you need.

• Large variety of network providers
• No-cost virtual visits
• Low- or no-cost prescription drugs

Ensuring access to high-quality, affordable care that meets the unique needs of each member.

Providing value by managing costs and improving the health of the people we serve.

UnitedHealthcare works with local organizations and the state of Texas to remove barriers to better health.

At UnitedHealthcare we want to make sure you can access all the benefits your plan provides.

If youve had a change in your health status and your doctor determines you need a wheelchair, your plan is here for you.

To make sure you get the equipment you need with the coverage you have, follow these simple steps.

You may need a wheelchair evaluation referral from a healthcare provider in your plans network for wheelchairs with special features.

Next a Durable Medical Equipment or DME vendor in your health plan network is located.

In many cases, your healthcare provider can help locate an in-network provider and send the referral.

If the health care provider does not complete this step we can help you find an in-network provider and schedule an appointment.

It is important to understand what your insurance does and does not cover, so that you dont have unexpected expenses.

And we can help you with that.

This evaluation may take place in your home or in the DME providers office.

Unitedhealthcare Individual & Family Aca Marketplace Plans In Texas

Looking for health care plans on the Affordable Care Act Marketplace? UnitedHealthcare Individual & Family ACA Marketplace plans offer affordable, reliable coverage options from UnitedHealthcare of Texas, Inc.

As part of the American Rescue Plan Act of 2021 and Inflation Reduction Act of 2022, many individuals and families are now eligible for lower or in some cases $01,2,3 monthly premiums for ACA Marketplace health coverage.

Call / TTY 711 to talk to a licensed insurance agent.

Already a member with a UnitedHealthcare Individual & Family ACA Marketplace plan? or call / TTY 711

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Unitedhealthcare Senior Care Options 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 plans 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.

What If I Get A Job After I Have Marketplace Coverage Open

• If you get a job and are offered a job-based health plan you should tell the Marketplace as soon as possible. You can cancel your Marketplace plan or keep it. But you may not be able to get lower costs based on your income. This will depend on whether the job-based plan is considered

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Health Insurance Rate Changes In Texas

In Texas, the average cost of health insurance across all tiers is $469 per month, a decrease of 6% between 2022 and 2023. This decline means that rates in 2023 are closer to what they were in 2021.

The average cost of a Silver health insurance plan in Texas for a 40-year-old is $589 per month, which is a 2% increase over last year.

The largest price decrease was for Gold plans, which cost an average of 20% less this year, a savings of about $130 per month. However, the average cost of a Silver plan increased slightly, by 2%.

Health insurance premium changes are set by the health insurance companies on a yearly basis. Before these premiums are set, they are first approved by the federal health insurance exchange.

Why Include Texas Health Care In Your Network Of Physicians

Texas Health Care, is a multi-specialty physician group practice with a current membership of more than 150 physicians throughout Tarrant County. Our physicians are highly regarded and known for providing excellent health care in North Texas. As part of our commitment to excellence in every aspect of our operation, we maintain a professional, hands-on business office with experienced personnel who are well-versed in all aspects of insurance billing, coding and coordinating with a variety of insurance companies and health plans. We monitor every aspect of our insurance-related activities and work closely with our providers to ensure the accuracy of our data and determine appropriate and timely reimbursement schedules. For further information about contracting with Texas Health Care PLLC, please contact our central business office at 817-740-8400.

In This Section

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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. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

When To Contact Your State Medicaid Or Chip Agency

Issues to take to your state Medicaid or CHIP agency include:

• You didnt get an enrollment card and arent sure youre covered
• You cant find a doctor who accepts Medicaid or CHIP, or you cant get an appointment
• You want to know if a service or product is covered
• You have a life change that may affect if youre eligible for Medicaid or CHIP like getting a job that increases your income, your dependent reaching an age where they no longer qualify, or getting married or divorced.

FILLING PRESCRIPTIONS IF YOU DONT HAVE A CARD: If you need to fill a prescription and havent received your enrollment card yet, check if your pharmacy accepts Medicaid, CHIP, or your health plan. If they do, take your eligibility letter and prescription to the pharmacy. Theyll try to fill it using the information in the letter.

If they dont have enough information, most pharmacies can give you enough medicine for 3 days. Call your Medicaid or CHIP agency or health plan for help getting the rest of your medicine.

If your pharmacy doesnt accept Medicaid, CHIP, or your health plan, call the number in your eligibility letter to find a pharmacy you can use. You can usually find this information on the state Medicaid or CHIP agency website too.

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Getting Your Claims Paid

If you have insurance, the hospital and/or physician likely will file a claim with your insurer. You will be billed for your deductible and copayment amount. Your health plan will send you an Explanation of Benefits that shows the amount billed, the amount paid by the health plan and the patients responsibility. The following resources may assist you in understanding how claims are filed and paid.

• Interpreting Your Explanation of Benefits This Patient Advocate Foundation webpage helps you understand the explanation of benefits you receive from your insurance administrator.
• Understanding Your Insurance Plan The Patient Advocate Foundation has an online publication to help you understand usual, customary and reasonable charges, and how your deductible/co-pay amounts work with charges.
• Understanding Your Bill in the Hospitals section provides more information.

Unitedhealthcare Connected For Mycare Ohio

UnitedHealthcare Connected® for MyCare Ohio 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 information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday 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 , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

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, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

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How Health Insurance Covers Expenses

When you choose a plan for Texas private health insurance, your insurance company charges a periodic amount called a premium. The premium is critical as it provides you with the opportunity to continue to obtain coverage for your medical expenses. The Texas insurance company pays for a large portion of your costs after you have met your specific threshold. This threshold includes the following expenses.

How Health Insurance Helps

Health insurance protects you before you get hurt or sick.

If you get hurt or sick and need to go to the doctor, health insurance protects you from paying high medical bills.

Health insurance is also called a health benefit plan. Health benefit plans cover preventative services like wellness visits, shots, and screening tests. These services help you stay healthy and avoid future health problems.

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Medicaid And The Childrens Health Insurance Program

for information on Texas Medicaid and CHIP.

There are two ways to apply for Medicaid:

Medicaid and the Childrens Health Insurance Program help cover medical expenses for children, some adults and people with disabilities who meet income requirements. Most services are delivered through providers called managed care organizations.

• Childrens Health Insurance Program is low-cost or free health coverage for children without health insurance.
• Childrens Medicaid covers services needed to keep kids healthy. It is for people 18 and younger healthy who come from families with little or no money.
• Long-term care Medicaid is available to some people who are older or who have a disability.
• Medicaid might be available to adults who are caring for a child.
• The Medicaid Buy-In program offers low-cost Medicaid health care services including community-based services and supports to individuals with disabilities who work.

Medicare

The Health Information, Counseling and Advocacy Program through Texas HHS can help you enroll in Medicare, find information, and provide counseling about your options.

Search For Health Plans

The four parts of a health plan to closely look at are:

Here are more questions to ask yourself when looking at a plan:

• Can I afford the monthly cost of this plan?
• Does this plan cover my healthcare needs? Does it cover any needs we know are coming this next year?
• Is my primary care provider in this plan’s network?
• If I need to see a specialist or go to the hospital, am I OK with this plan’s options?

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Best For Dental And Vision: Ambetter

Ambetter

• One of few providers to offer some exchange plans with dental and vision

• Offers EPO plans with no specialist referral required

• $0 virtual urgent care

• 2-star plan rating on Healthcare.gov

• Relatively high-cost bronze and silver plans

Ambetter offers plans with adult dental and vision coverage, which is a rarity among marketplace providers. These plans may include an annual childrens eye exam and glasses as well, but not child dental. Ambetters health insurance plans with dental and vision benefits are EPOs, which means you dont need a primary care doctors referral to see a specialist. Youll still be limited to in-network doctors, however. Ambetter also offers 24/7 virtual care along with $0 urgent care, which can save you a lot of cash.

But the estimated annual cost of Ambetters silver and bronze plans is relatively high for people with low and medium medical needs. Unless it makes sense for you to purchase a gold plan, you may want to opt for one of Aetnas plans and purchase private dental coverage separately. Ambetter plans have just a 2-star rating on Healthcare.gov, which means you may get better quality with a plan from Blue Cross Blue Shield.

Getting Help From Member Services

Our Member Services department can answer all of your questions. We can help you choose or change your Primary Care Provider , find out if a service is covered, get referrals, find a provider, replace a lost ID card, report the birth of a baby and explain any changes that might affect you or your familys benefits.

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When Is Open Enrollment For Health Insurance

Open enrollment for health insurance in Texas begins November 1. To get a health insurance plan starting in January of 2023, youll need to enroll by December 15. If you enroll after that, youll have until January 15 to get coverage for February. To be eligible to use the marketplace, youll just need to live in and be lawfully present in the United States and not incarcerated.

Choose A Plan & Enroll

• 2018 Plan Rates for Texas

Disclaimer: In some cases, the enrollee share of premiums for the Self Plus One enrollment type will be higher than the Self and Family enrollment type. Enrollees who wish to cover one eligible family member are free to elect either the Self and Family or Self Plus One enrollment type. Check premiums on our website at www.opm.gov/fehbpremiums.

Nationwide Fee-for-Service Open to All

Nationwide Fee-for-Service Plans Open Only to Specific Groups

State Specific HMO, HDHP and CDHP Plans

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What Is Chip And Childrens Medicaid

CHIP is a health care program for children without health insurance whose families earn too much to get Medicaid but cannot afford health insurance. Childrens Medicaid is a healthcare program for children in low-income families.

For more information about options, and to find out about eligibility, visit the website of Texas Health and Human Services. Also, visit YourTexasBenefits.com.

What Health Plans Cover

Coverages vary by plan. Coverage requirements are different for plans you get at work and those you buy directly from an insurance company. Even among plans you get at work, the requirements are different depending on whether you work for a small employer or a large one. If you ask, your plan must give you a Summary of Benefits and Coverages.

Federal law requires individual and small-employer plans to cover 10 types of health care services, called essential health benefits. In addition, Texas requires some plans to include certain health benefits. Some plans might cover more services, like adult dental and vision care and weight management programs.

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Other Types Of Coverage

These types of health insurance provide only limited coverage. Companies selling them can deny you coverage or charge you more if you have a preexisting condition. They also usually limit the amount they will pay for your care.

• Specified disease policies pay only if you have the illness named in the policy. For instance, a cancer policy will pay only if you have cancer. It wont pay if you have another disease.
• Short-term policies provide coverage for only a limited time, usually six to 12 months. People sometimes buy these policies while they’re between jobs or waiting for other coverage to start.

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