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Medicare Advantage plans are Part C plans that are offered by private insurers like UnitedHealthcare. They offer all the benefits of Original Medicare Part A and Medicare Part B. Many Medicare Advantage plans include prescription drug coverage (Part D) and typically include additional benefits, features, and programs. You must remain enrolled in Medicare Part A and Part B to be eligible for a Medicare Advantage plan.
APWU Health Plan has been serving retirees for 60 years. Retirees make up a big portion of our plan population, and they are very important to us. We thank you for your service to our country and now it’s our turn to take care of you. APWU Health Plan designed this Medicare Advantage plan in collaboration with UnitedHealthcare to provide an enhanced level of benefits, which focuses more closely on senior health and well-being.
The UnitedHealthcare Medicare Advantage for APWU Health Plan offers all the benefits of Original Medicare Part A and Medicare Part B, plus prescription drug coverage (Part D) and additional benefits, such as a $85 monthly Medicare Part B subsidy, a Renew Active® fitness benefit, UnitedHealthcare® HouseCalls and much more.
This is a custom Group Medicare Advantage (PPO) plan designed exclusively for APWU Health Plan’s High Option members. This plan is different and should not be confused with individual UnitedHealthcare Medicare Advantage plans that might be available in the area.
Typically, enrollment into a Medicare Advantage plan would cause a suspension or termination to FEHBP coverage. However, the Medicare Advantage for APWU Health Plan was designed for FEHBP retirees to allow you to retain your status in FEHBP.
No, you must remain enrolled in the APWU Health Plan to be eligible for the Medicare Advantage plan. If you suspend your APWU Health Plan coverage, you will also be terminated from the Medicare Advantage plan.
There is no additional cost to enroll in the Medicare Advantage plan. You will continue to pay your APWU Health Plan High Option premium as well as your Medicare Part B premium. You will receive a Medicare Part B subsidy of $85 per month when enrolled in the Medicare Advantage plan.
- If you are already enrolled in the APWU Health Plan, please call UnitedHealthcare to enroll in the UnitedHealthcare Medicare Advantage (PPO) plan for APWU Health Plan toll-free at 1-855-383-8793, TTY 711, 8 a.m. to 8 p.m. local time, 7 days a week
- If you are not yet a member of the APWU Health Plan, you’ll need to enroll during Open Season with the Office of Personnel Management (OPM). Once your enrollment into the APWU Health Plan has been processed and confirmed by OPM, you can call UnitedHealthcare to enroll in the UnitedHealthcare Medicare Advantage (PPO) plan for APWU Health Plan toll-free at 1-855-383-8793, TTY 711, 8 a.m. to 8 p.m. local time, 7 days a week.
- Enrollment in Medicare Advantage is voluntary, retirees may opt in or out of the enhanced level of benefits at any time throughout the year
Dependents who are not Medicare eligible or Medicare primary will remain on the APWU High Option plan.
Yes, this plan offers nationwide coverage.
Network providers have a contract with UnitedHealthcare. Out-of-network providers do not have a contract. With the APWU Health Plan, you have the flexibility to see any provider (in or out of the network) at the same cost share, as long as the provider has not opted out of Medicare and accepts the plan. Also, when you go out-of-network for care, the plan pays providers just as much as Medicare would have paid.
You will pay the same cost share in or out of the network, so there is no balance billing. However, if your provider bills you, please call UnitedHealthcare Customer Service at 1-855-383-8793, TTY 711, 8 a.m.-8 p.m. local time, 7 days a week.
Yes, coverage is available outside of the United States.
Yes, this plan offers dental coverage.
Your UnitedHealthcare member ID card will arrive approximately 2 weeks after your enrollment has been submitted and confirmed. You will use your UnitedHealthcare Group Medicare Advantage member ID card for all covered medical and prescription drug services.
You may need a new prescription. Beginning Jan. 1, 2022, your Home Delivery pharmacy will be OptumRx, a UnitedHealth Group company. The Quick Start Guide that you receive following your enrollment in the plan will include OptumRx contact information.
If you had a Medicare Part D plan or coverage through FEHBP that included prescription drug coverage, you had what is known as “creditable coverage.” Creditable coverage means that your prescription drug coverage was at least as good as, or better than, what Medicare requires. If you had creditable prescription drug coverage through another source, such as a spouse’s employer plan, you should have received a certificate of creditable coverage. This certificate is generally provided prior to tax season. If you were eligible for Medicare Part D and you did not have any prescription drug coverage for more than 63 days, Medicare will determine if you need to pay a late enrollment penalty (LEP) for the length of time you were eligible but did not have Part D coverage. You may submit an appeal to have this LEP removed if you had creditable coverage. You will receive a letter from UnitedHealthcare if Medicare has reported a gap of more than 63 days with instructions on how to appeal this and provide proof of creditable coverage.
IRMAA stands for Income-Related Monthly Adjustment Amount. Similar to Medicare Part B, high-income earners will pay more for their Medicare Part D coverage. If you are a member of a Medicare plan that includes prescription drug coverage and your modified adjusted gross income on your IRS tax return from 2 years ago is above $87,000* for an individual or $174,000* for a couple, you may pay an additional amount for Medicare Part D coverage. The extra amount is paid directly to Social Security, not to your plan. If you are subject to IRMAA, Social Security will send you a letter. The letter will explain how they determined the amount you must pay and the actual IRMAA. Neither APWU nor your health plan determine who will be subject to IRMAA. Therefore, if you disagree with the amount you must pay, contact the Social Security Administration. You can:
- Go online to ssa.gov
- Call Social Security toll-free at 1-800-772-1213, TTY 1-800-325-0778, 8 a.m.–7 p.m., Monday–Friday
- Visit your local Social Security office
* These amounts are accurate for 2021.
The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.
Out-of-network/non-contracted providers are under no obligation to treat APWU Health Plan members, except in emergency situations. Please call our Customer Service number or see your Evidence of Coverage for more information.
Participation in the Renew Active® program is voluntary. Consult your doctor prior to beginning an exercise program or making changes to your lifestyle or health care routine. The information provided through Renew Active is for informational purposes only and is not medical advice. Gym network may vary in local market.
HouseCalls may not be available in all areas.
OptumRx is an affiliate of UnitedHealthcare Insurance Company. You are not required to use OptumRx Home Delivery to supply your maintenance medication. If you have not used OptumRx Home Delivery, you must approve the first prescription order sent directly from your doctor to OptumRx before it can be filled. Prescriptions from OptumRx should arrive within 5 business days after we receive the complete order. Contact OptumRx anytime at 1-888-279-1828, TTY 711
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare.