Medica HealthCare Medicare Advantage Special Needs Plans (SNPs) are HMO plans in Miami-Dade and Broward counties. These plans combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional benefits and services designed to meet the unique needs of identified Medicare consumer populations.
Medica HealthCare Dual Eligible SNP plans are intended for consumers eligible for Medicare & Medicaid benefits.
- Medica HealthCare Plans MedicareMax Plus (HMO SNP)
Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. The Medica Healthcare HMO plans require referrals for specialty care.
Medica HealthCare is insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare.
Tools and Resources - Medica HealthCare Special Needs Plans of Florida
- Chronic Condition Verification Form
- Medicare Advantage Chiropractic and Acupuncture Coverage – Quick Reference Guide
- Medicare Advantage Copayment Guidelines
- Medicare Advantage Durable Medical Equipment (DME) Frequently Asked Questions
- Medicare Advantage Member Rights and Responsibilities
- Medicare Advantage Non-Contracted Provider Dispute and Appeal Rights
- Medicare Advantage Non-Contracted Provider Claim Payment Dispute Request Form
- Medicare Advantage Preventive Screening Guidelines
- Medicare Advantage Service Area Reductions for 2020 Frequently Asked Questions
- Readmission Review Program Clinical Guidelines
- Readmission Review Program Frequently Asked Questions
- Special Needs Plans (SNP) Benefit Plan Name Overview
- UnitedHealthcare Administrative Guide
- Medicare Advantage Drug Formulary - UHCMedicareSolutions.com (enter zipcode and select plan)
Additional Coverage Information
Coverage options may vary depending upon your location. To learn more about a plan in your service area, go to Medicaplans.com.
Medicare Part D Information
To learn more about Medicare Part D prescription drug coverage or to access related forms, please review the Prescription Drug Resources materials available on MedicaPlans.com. This section contains information and forms for direct member reimbursement, medication prior authorization, and the prescription drug transition process.
Reminder for Special Needs Plan Providers
UnitedHealthcare provides Special Needs Plan (SNP) care providers access to SNP beneficiaries' Health Risk Assessments (HRAs) and Individualized Care Plans (ICPs) in a variety of ways including mailing, faxing, uploading to the Provider Portal or placing Individualized Care Plans in the SNP beneficiary's physical and/or electronic chart.
Care providers should be reviewing the SNP beneficiary's Individualized Care Plans and participating with the SNP Interdisciplinary Care Team to coordinate the beneficiary's care. Special Needs Plan care providers can register online at UHCprovider.com to begin accessing and reviewing SNP beneficiary Individualized Care Plans via the Care Conductor Tool on Link.