United Healthcare 2015 Annual Report Download - page 8

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long-term payment rate outlook for each geographic area. Starting in 2012, and phased in through 2017, the
Medicare Advantage rate structure and quality rating bonuses are changing significantly. See Part II, Item 7,
“Management’s Discussion and Analysis of Financial Condition and Results of Operations” for further
information.
UnitedHealthcare Medicare & Retirement offers innovative care management, disease management and other
clinical programs, integrating federal, state and personal funding through its continuum of Medicare Advantage
products. For high-risk patients in certain care settings and programs, UnitedHealthcare Medicare & Retirement
uses proprietary, automated medical record software that enables clinical care teams to capture and track patient
data and clinical encounters, creating a comprehensive set of care information that bridges across home, hospital
and nursing home care settings. Proprietary predictive modeling tools help identify members at high risk and
allow care managers to reach out to those members and create individualized care plans that help them obtain the
right care, in the right place, at the right time.
Medicare Part D. UnitedHealthcare Medicare & Retirement provides Medicare Part D benefits to beneficiaries
throughout the United States and its territories through its Medicare Advantage and stand-alone Medicare Part D
plans. UnitedHealthcare Medicare & Retirement offers two stand-alone Medicare Part D plans: the AARP
MedicareRx Preferred and the AARP MedicareRx Saver Plus plans. The stand-alone Medicare Part D plans
address a large spectrum of beneficiaries’ needs and preferences for their prescription drug coverage, including
low cost prescription options. Each of the plans includes the majority of the drugs covered by Medicare and
provides varying levels of coverage to meet the diverse needs of Medicare beneficiaries. As of December 31,
2015, UnitedHealthcare enrolled more than 8 million people in the Medicare Part D programs, including more
than 5 million individuals in the stand-alone Medicare Part D plans and more than 3 million in Medicare
Advantage plans incorporating Medicare Part D coverage.
Medicare Supplement. UnitedHealthcare Medicare & Retirement is currently serving more than 4 million seniors
nationwide through various Medicare Supplement products in association with AARP. UnitedHealthcare
Medicare & Retirement offers a full range of supplemental products at diverse price points. These products cover
the various levels of coinsurance and deductible gaps that seniors are exposed to in the traditional Medicare
program.
UnitedHealthcare Community & State
UnitedHealthcare Community & State is dedicated to serving state programs that care for the economically
disadvantaged, the medically underserved and those without the benefit of employer-funded health care
coverage, in exchange for a monthly premium per member from the state program. In some cases, these
premiums are subject to experience or risk adjustments. UnitedHealthcare Community & State’s primary
customers oversee Medicaid plans, Children’s Health Insurance Programs (CHIP), SNPs, integrated Medicare-
Medicaid plans (MMP) and other federal, state and community health care programs. As of December 31, 2015,
UnitedHealthcare Community & State participated in programs in 24 states and the District of Columbia, and
served more than 5 million beneficiaries. Health Reform Legislation provided for optional Medicaid expansion
effective January 1, 2014. Currently, UnitedHealthcare Community & State serves people through Medicaid
expansion programs in 13 states. For further discussion of the Medicaid expansion under Health Reform
Legislation, see Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of
Operations.”
States using managed care services for Medicaid beneficiaries select health plans by using a formal bid process
or by awarding individual contracts. A number of factors are considered by UnitedHealthcare Community &
State when choosing programs for participation, including the state’s commitment and consistency of support for
its Medicaid managed care program in terms of service, innovation and funding; the eligible population base,
both immediate and long term; and the structure of the projected program. UnitedHealthcare Community & State
works with its state customers to advocate for actuarially sound rates that are commensurate with medical cost
trends.
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