What type of insurance is UnitedHealthcare Choice Plus?

UnitedHealthcare Choice Plus is a type of preferred provider organization (PPO) health insurance plan offered by UnitedHealthcare, one of the largest health insurance providers in the United States.

What is a PPO health insurance plan?

A PPO plan is a type of health insurance plan that offers more flexibility in choosing healthcare providers compared to other types of plans like HMOs. Here are some key features of PPO plans:

• Nationwide network of providers – PPO plans allow you to see any doctor or hospital within their entire provider network. This network is usually very large and provides coverage across the U.S.

• Out-of-network coverage – You can choose to see providers outside the PPO network, albeit at higher costs. Out-of-network care is not covered by HMOs.

• No referrals required – You do not need a referral from a primary care physician to see a specialist. This allows more flexibility in accessing care directly.

• Lower costs for in-network care – Seeing providers within the PPO network results in lower out-of-pocket costs for the insured compared to out-of-network care.

Key Features of UnitedHealthcare Choice Plus

As a PPO plan, UnitedHealthcare Choice Plus includes the general benefits of PPOs mentioned earlier. Here are some specific features of this plan:

• Nationwide network – Choice Plus utilizes UnitedHealthcare’s large national network of over 1 million providers and 6,000 hospitals. This extensive network provides access to care throughout the U.S.

• No referrals required – You can directly access any network specialist or hospital without needing a referral. This allows more flexibility in choosing doctors.

• Out-of-network coverage – Choice Plus covers out-of-network providers but at a higher cost to the insured compared to the in-network rate.

• Preventive care covered at 100% – All nationally recommended preventive care screenings and immunizations are covered at no cost when using in-network providers. This includes checks ups, cancer screenings, vaccinations and more.

• Deductible and coinsurance – There is an annual deductible you must meet before coverage kicks in. After this, you pay a coinsurance percentage for care until you reach the annual out-of-pocket maximum.

• Health savings account (HSA) compatible – Choice Plus is compatible with and HSA if you also enroll in an HSA-eligible HDHP plan. You can use tax-advantaged HSA funds to pay for care.

• Virtual visits – Telehealth options are available to see doctors over video chat, phone or app for minor acute care needs. This provides easy access to care.

• Wellness programs – UnitedHealthcare offers wellness incentives, personalized health resources and coaching to help encourage healthy behaviors.

Comparing UnitedHealthcare Choice Plus Plans

UnitedHealthcare offers a few versions of the Choice Plus plan at different coverage levels. Here is an overview:

• Choice Plus PPO – This is the standard version with a nationwide network. It has copays for office visits and covers preventive services at 100%. You pay deductible and coinsurance for other care until the out-of-pocket max.

• Choice Plus PPO Bronze – This is a bronze level plan. It has lower premiums but higher out-of-pocket costs. The deductible is higher and there is coinsurance for office visits after the deductible. Preventive care is covered before deductible.

• Choice Plus PPO Silver – This silver level plan has moderate premiums and out-of-pocket costs. There are copays for office visits and deductible/coinsurance for other care. It covers preventive services at 100%.

• Choice Plus PPO Gold – This gold level plan has higher premiums but lower out-of-pocket costs. There are copays for office visits. The deductible is lower and there are flat dollar copays for certain services after deductible.

The metal levels allow you to balance monthly premium cost with your out-of-pocket risk tolerance. Higher metal plans have more coverage but cost more per month.

Pros and Cons of UnitedHealthcare Choice Plus

Here are some potential advantages and disadvantages of the UnitedHealthcare Choice Plus plan:

Pros

• Large national network provides good access to care
• No referrals needed to see specialists
• Coverage for out-of-network care provides flexibility
• Range of plan options at different metal levels
• Compatible with HSAs to combine savings and coverage
• Virtual visits available for convenient minor care
• Covers preventive services at 100% in-network

Cons

• Out-of-network care results in higher costs for insured
• Plans with lower premiums have high deductibles and out-of-pocket costs
• Not compatible with FSAs due to HSA compatibility
• Must meet deductible first before coverage kicks in
• No out-of-network coverage on some bronze plans

Overall, the Choice Plus offers comprehensive medical coverage with flexibility to see the providers you want. But premiums, deductibles and provider network should be considered when selecting a specific plan.

Who is eligible to enroll in Choice Plus?

UnitedHealthcare Choice Plus is primarily available to:

• Individuals – Choice Plus plans can be purchased directly online by individuals and families without employer coverage.

• Employer groups – Many employers offer Choice Plus to their employees as part of company health benefits.

• Medicare Advantage – Some Choice Plus plans are designed for individual Medicare members as Medicare Advantage PPO plans.

Eligibility for specific plans varies depending on state and plan rules. Certain individual and family plans have restrictions for who can enroll based on factors like age, location, and income. Employer plans will have enrollment conditions set by the employer.

How does coverage work with Choice Plus?

The Choice Plus plan covers a comprehensive set of medical services ranging from preventive care to hospitalization. Here is an overview of how coverage works:

• Preventive care – All nationally recommended preventive services like immunizations, cancer screenings, annual check ups and more are covered at 100% when you see in-network providers. You pay nothing for these services.

• Doctor visits – You pay a copay for in-network primary care, specialist, and urgent care visits. Copays are fixed dollar amounts (e.g. $30 primary care copay). Out-of-network visits are covered but cost more.

• Lab tests – Medically necessary lab work is covered but subject to deductible and coinsurance, except for preventive lab tests ordered during wellness exams.

• Imaging – X-rays, MRIs, CT scans etc. require deductible and coinsurance payments first unless part of preventive screening.

• Surgery – Operating room fees, surgeon fees and hospital fees for medically necessary surgery are covered after deductible/coinsurance payments.

• Hospital stays – Hospitalization is covered after you pay your deductible and coinsurance. Inpatient mental health services have coverage as well.

• Emergency care – Emergency room visits within the U.S. are covered after you pay deductible and coinsurance, in and out-of-network.

• Prescription drugs – Prescriptions filled at a pharmacy are covered after you pay your deductible/coinsurance or copay (on copay plans).

Often Preventive services are covered first before the deductible. After your deductible is met, you pay coinsurance until reaching the annual out-of-pocket maximum. Higher coinsurance rates apply for non-emergency out-of-network care.

What are the costs of Choice Plus plans?

The costs for Choice Plus plans vary significantly depending on the individual plan benefits, coverage level, geographic location, age of members, and more. Here is an overview:

• Premiums – Monthly premiums can range anywhere from $200 to $800 for individual coverage, and $500 to $2000 for family coverage, depending on the plan. Bronze plans have lower premiums than gold plans.

• Deductibles – The annual deductible can be anywhere from $1,000 on a gold plan to $7,000 on a bronze plan. It must be paid before coverage kicks in.

• Copays – Copays for primary care visits can be around $20-50 with specialists being $50-100 visits on many plans. Copays do not apply to all services.

• Coinsurance – The coinsurance percentage is usually around 20% for in-network care once the deductible is met. This means you pay 20% of allowed charges. It is higher for non-emergency out-of-network care.

• Out-of-pocket max – This caps your total spending for the year. It ranges from around $2,000 to $8,500 depending on the