UnitedHealthcare Offers Lower Doctor Visit Co-Pays to Many Medicare Advantage Members in North Carolina

In a consumer breakthrough tied to new ways of organizing health care, UnitedHealthcare will offer many of its Medicare Advantage members in North Carolina lower co-pays when they receive care from primary care providers and most specialists affiliated with Cornerstone Health Care, Eagle Physicians & Associates, Guilford Medical Associates, Novant Health and Triad HealthCare Network.

Referred to as “tier 1 care providers” to help members easily identify them, these providers participate in accountable care programs with UnitedHealthcare and meet other performance criteria. They have committed to being compensated based on their ability to improve the coordination and delivery of care to UnitedHealthcare’s Medicare Advantage members, thereby closing gaps in care, reducing redundant, inefficient care, and improving health outcomes, all while lowering the overall cost of care.

Nearly 55,000 beneficiaries enrolled in three AARP MedicareComplete (HMO) Medicare Advantage plans in North Carolina will pay a lower co-pay for a standard office visit when they visit a tier 1 primary care provider or specialist. [*]

The co-pays for primary care provider visits will vary based on the member’s plan.

• People enrolled in the AARP MedicareComplete Plan 1 (HMO) and AARP MedicareComplete Essential (HMO) plans will pay a $0 co-pay for visits with tier 1 primary care providers, as compared to $10 for tier 2 primary care providers.
• People enrolled in the AARP MedicareComplete Plan 2 (HMO) will also pay a $0 co-pay for visits with tier 1 primary care providers, as compared to $20 for tier 2 primary care providers.

People enrolled in all three plans will pay a $35 co-pay for standard office visits with tier 1 specialists, as compared to $50 for tier 2 specialists.