Medicare Advantage Plans, also known as MA, MAPD or Part C, are Medicare approved insurance plans administered by private companies like UnitedHealthCare. These plans take the place of and combine original Medicare benefits Parts A–Hospital, B–Medical/DME and may include D–Prescription drug. They cover all the services that original Medicare Part B covers. Dual Eligibles are Medicare beneficiaries who are also eligible for some level of Medicaid assistance.

Network pharmacies can submit some Part B covered medications/supplies through the OptumRx RxClaims system and these claims will process and pay under the Part B benefit of the Member’s UnitedHealthCare Medicare Advantage Plan. If the Member has QMB (Qualified Medicare Beneficiary) or other qualifying Medicaid coverage the pharmacy must refrain from Balance Billing the Member for the Part B copay. Claims should be submitted to Medicaid for payment.

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