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APWU Health Plan FAQ

APWU Health Plan has been offering affordable, comprehensive coverage to postal workers, federal employees, and retirees since 1960. We’re here to help you choose a plan that’s right for you and make the most of your benefits.

If you can’t find an answer to your question, contact us to speak with a customer service representative:

1-800-222-2798 | 1-800-622-2511 (TTY)

Monday – Friday, 8:30 am – 6:30 pm ET

Displaying FAQs for High Option

How do I access the confidential 24-hour nurse line?

As a High Option member, you can get answers to your health questions 24 hours a day. Registered nurses are available to discuss existing medical concerns and provide information about numerous healthcare issues.

Call 1-866-873-8738

Call 911 for a true emergency.

Can I get an estimate for how much a procedure will cost before I receive treatment?

Estimate costs—including your deductible, coinsurance, and out-of-pocket maximum—before you see a doctor or healthcare provider.

Search for providers and facilities in the UnitedHealthcare network, and narrow your search results by specialty, procedure, or doctor.

High Option members: To get started, log in to the Viveka Health Price Transparency Tool with your member ID and date of birth. You can find your member ID on your Health Plan ID card or by logging in to your member portal.

Consumer Driven Option members: Log in to your myuhc.com member portal.

What is Medicare Part D IRMAA and does it apply to me?

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 a certain limit, 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 Health Plan 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:

Go online to ssa.gov
Call Social Security toll-free at 1-800-772-1213, TTY 1-800-325-0778, 8 am–7 pm, Monday–Friday
Visit your local Social Security office

Will I be penalized for not having drug coverage through APWU Health Plan previously?

If you had a Medicare Part D plan or coverage through PSHB or FEHB 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.

Do I need to get new OptumRx® Home Delivery mail-order prescriptions?

You may need a new prescription. Your Home Delivery pharmacy is OptumRx, a UnitedHealth Group company. The Quick Start Guide that you receive following your enrollment in the plan will include OptumRx contact information.

Medicare Advantage pharmacies and prescriptions

When will I get my UnitedHealthcare member ID card?

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.

Does this plan have dental coverage?

Yes, our Medicare Advantage plan offers dental coverage.

Is there coverage outside of the United States?

Yes, with our Medicare Advantage plan coverage is available outside of the United States.

Are there any situations when a provider will balance bill me?

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 am – 8 pm CT, Monday – Friday.

What is the difference between network and out-of-network providers? How does this difference affect the total amount that I can expect to pay for services when using out-of-network providers?

Network providers have a contract with UnitedHealthcare. Out-of-network providers do not have a contract. With 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.

How do I find out if my provider is in the network?

To learn if your provider is in the network, go to retiree.uhc.com/apwuhp.

Is the plan nationwide?

Yes, our Medicare Advantage plan offers nationwide coverage.

APWU Health Plan FAQ

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