Navigating health care can be complex, and we are here to help make it simpler. Members will be receiving a communication to help them get started on their plan. Additionally, to support transparency around some of the misinformation in the media about our company, new information has been published for our members on uhc.com.

For your reference, we’ve also included these FAQs below.

How does UnitedHealthcare help members navigate health care?
 

The team at UnitedHealthcare works to help our members each day by providing simple experiences, affordable coverage and high-quality care. We design plans that support your health and help you easily get care within a complicated health care system. We support you by: 

• Managing costs to help save you money. 
• Making it simpler to find and access care. 
• Helping you get quality care that’s in step with the most up-to-date medical standards. 
• Offering preventive and care programs, like annual health visit reminders, maternity health, chronic condition management, cancer screenings, wellness, mental health support, and more.  

On every step of your health care journey, we work to be advocates, guides and partners. We are here to help, so you can focus on what matters to you.  

Read more about how we support our employer clients, state and federal clients, members, and providers on our UnitedHealthcare newsroom.  

What is UnitedHealthcare’s claim approval rate? 

We ultimately pay 98% of all claims received that are for eligible members, when submitted in a timely manner with complete, non-duplicate information. For the 2% of claims that are not approved, the majority are instances where the services did not meet the benefit criteria established by the plan sponsor, such as the employer, state or Centers for Medicare & Medicare Medicaid Services (CMS). Only 0.5% of claims are not approved based on clinical evidence and patient safety.

Our care teams are focused on supporting patient safety, evidence-based care, and treatment in the optimal care setting. We continuously evaluate and refine our processes to make it easier for patients and their families. 

You can find information on the claim appeals process online: UHC Medicare Advantage plans, UHC Medicaid and Community plans and employer-sponsored health plans. For our Medicare Supplement members, Original Medicare determines if medical services and supplies are approved. If approved, claims are then processed based on the specific benefits provided under your AARP Medicare Supplement plan. 

Throughout your health care journey, UnitedHealthcare is committed to working with you and providers every step of the way. 

What is the role of prior authorizations? 
 

When our members seek care, over 99% of the time there is no prior approval needed, or the approval is obtained quickly (with an average of 2 days or less) so care is not delayed. Prior authorization is an important checkpoint to ensure a service or procedure is a safe and medically appropriate option. Prior authorization also helps ensure members don’t pay out-of-pocket for care they don’t need.

Will my current premium or costs go up? 

No, your current plan coverage will not change because of recent events. As with every year, any increases in premiums or costs are communicated ahead of time. This communication usually happens during the annual or open enrollment period. 

For example, Medicare Advantage and Part D plan benefits are approved annually by the Centers for Medicare & Medicaid (CMS) and are set for 2025. CMS is the federal agency that regulates all insurance carriers.

How does UnitedHealthcare use artificial intelligence? 
 

Artificial intelligence (AI) and machine learning (ML) can help make health care work smarter for our customers, members, providers and consumers. 

Our teams are focused on developing and using tools that empower people. These tools can give better insights, more timely information and better experiences. At the same time, they keep safety, privacy and transparency a priority. 

We work to ensure that AI and ML models are used safely and responsibly to enable and support decision-making. These tools do not replace critical human decision-making.

Why did some Medicare Advantage plan premiums and benefits change in 2025?
 

The federal government made several regulatory changes that impacted all 2025 Medicare plans, including those UnitedHealthcare offers. These government changes resulted in lower funding for Medicare Advantage across the industry and increased plan responsibility for coverage of prescription drug costs. 

UnitedHealthcare’s 2025 plans continue to reflect the ease, value and experience our members have come to count on and continue to deliver the benefits members tell us matter most to them. To help ensure stability in the most utilized benefits, UnitedHealthcare made changes in coverage and premiums.

• We continue to offer many $0 premium Medicare Advantage plans that include a $0 cost-share for preventive care visits, plus dental, vision, hearing and fitness benefits. 
• Beyond great benefits, our plans continue to offer access to a broad provider network and member rewards and discount programs that are designed to provide even more value to our Medicare Advantage members. 
• Additionally, the UnitedHealthcare Medicare Advantage formulary will cover more of the most-used Tier 1 prescriptions than any other national carrier, which reflects our commitment to providing affordable access to the prescriptions.

From choosing your plan, to using your plan, to enjoying your whole life ahead, UnitedHealthcare is committed to supporting you every step of the way.

How are Medicare prescription drug plans different in 2025? 

There are industry-wide changes to Medicare Part D prescription drug coverage in 2025 resulting from the Inflation Reduction Act. These changes aim to lower prescription costs for many members with Part D coverage, regardless of insurer. 

There are two primary changes to prescription coverage: 

• Elimination of the Coverage Gap or Medicare Part D “donut hole”: 
  In 2025, there are only three Part D prescription drug coverage stages: Deductible (depending on your plan), Initial Coverage and Catastrophic Coverage.
• Lower maximum out-of-pocket drug costs: In 2024, Medicare members were required to hit an $8,000 out-of-pocket maximum on prescription drug expenses before entering the Catastrophic Coverage stage. In 2025, this out-of-pocket maximum is now $2,000.

Depending on your prescriptions, members with Part D coverage may experience these updates differently. Learn more about Part D changes or explore your pharmacy benefits

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