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Medicare Advantage VBID hospice model

UnitedHealthcare will end our voluntary participation in the CMS Value-Based Insurance Design (VBID) hospice plan on Dec. 31, 2023.

In those states where UnitedHealthcare previously participated in this pilot program, we’ll continue to cover hospice services through discharge for any plan member who elects hospice by Dec. 31, 2023, in a participating VBID hospice plan. Services should continue to be billed to UnitedHealthcare for those members. For members who elect hospice on or after Jan. 1, 2024, Original Medicare will cover the member’s hospice services.

Impacted plans

On Dec. 31, 2023, we’ll discontinue our participation in the VBID hospice model, which will impact the following plans. No UnitedHealthcare plans will be included in the VBID hospice model in 2024.

State Plan ID 2023 plan name
Alabama H0432-003-000 AARP® Medicare Advantage Plan 1
Alabama H0432-004-000 AARP® Medicare Advantage Plan 2
Alabama H0432-009-000 UnitedHealthcare Dual Complete
Alabama H0432-010-000 AARP® Medicare Advantage Walgreens
Alabama H0432-012-000 AARP® Medicare Advantage Patriot
Alabama H0432-013-000 UnitedHealthcare Dual Complete Select
Alabama H1889-009-000 UnitedHealthcare Dual Complete Choice
Alabama H2802-041-000 AARP® Medicare Advantage Plan 3
Alabama H2802-044-000 UnitedHealthcare Dual Complete Select
Alabama H6528-033-000 AARP® Medicare Advantage Choice
Illinois H0271-004-000 AARP® Medicare Advantage Walgreens
Illinois H8768-005-000 AARP® Medicare Advantage Choice
Illinois H8768-010-000 AARP® Medicare Advantage Walgreens
Oklahoma H0271-053-000 UnitedHealthcare Dual Complete Choice
Oklahoma H3749-001-000 AARP® Medicare Advantage Flex
Oklahoma H3749-017-000 AARP® Medicare Advantage Flex Plus
Oklahoma H3749-018-000 AARP® Medicare Advantage
Oklahoma H3749-020-000 AARP® Medicare Advantage Navigate
Oklahoma H5322-031-000 UnitedHealthcare Dual Complete LP
Oklahoma H5322-033-000 UnitedHealthcare Dual Complete Select
Oklahoma H8125-003-000 UnitedHealthcare Dual Complete LP
Oklahoma H8768-008-000 AARP® Medicare Advantage Choice Plan 1
Oklahoma H8768-009-000 AARP® Medicare Advantage Choice
Oklahoma H8768-016-000 AARP® Medicare Advantage Choice Plan 2
Oklahoma H8768-028-000 AARP® Medicare Advantage Patriot
Texas H4527-001-000 AARP® Medicare Advantage

Check member enrollment

Our participation in the pilot program will end on Dec. 31, 2023. To check if your patient is enrolled in an impacted plan, go to the:

  • UnitedHealthcare Provider Portal: Check benefits and plan enrollment. Sign In at the top of this page with your One Healthcare ID.
  • CMS HIPAA Eligibility Transaction System (HETS): Use the CMS HIPAA Eligibility Transaction System (HETS) to verify enrollment in an approved plan.

We’ll cover hospice services through discharge for any plan member who elects hospice in a designated plan by Dec. 31, 2023.

Notifications and claims

If a patient is obtaining VBID hospice services through 2023, send all notices and claim submissions to both UnitedHealthcare and the CMS Medicare Administrative Contractor (MAC). For patients who elect hospice after Dec. 31, 2023, submit all notices and claims only to the MAC.

We’ll cover hospice services through discharge for any plan member who elected hospice in a designated VBID plan by Dec. 31, 2023. Plan members who elect hospice on or after Jan. 1, 2024, will be covered under Original Medicare.

In-Network Provider Guidance
Out-of-Network Provider Guidance

Hospice care navigation
Members can choose to have a pre-hospice consultation through Dec. 31, 2023. To request a consultation, members should call the number on the back of their ID card. We’ll cover hospice services through discharge for any plan member who elected hospice in the designated plans by Dec. 31, 2023.

Transitional concurrent care
No transitional concurrent care services will be approved after Dec. 31, 2023. All previously approved services will end on or before Jan. 31, 2024. Transitional concurrent care is only available to members covered by one of the UnitedHealthcare designated VBID plans and elect hospice at an in-network provider. Transitional concurrent care services are not covered if a member chooses an out-of-network hospice provider.

If it is determined that Transitional Concurrent Care is appropriate for a member, in-network hospice providers must:

  • Receive approval from Optum Hospice Guide prior to the member receiving services by calling 833-753-2970.
  • Work with the member or member’s authorized representative to complete a Transitional Concurrent Care Addendum. The addendum outlines the services that a member will receive as they transition into hospice and the date treatment will discontinue.
  • The hospice provider is required to submit a Transitional Concurrent Care Addendum within 3 calendar days of approval of coverage and hospice admission via secure email to Optum Hospice Guide at HospiceTCC@optum.com.

For questions on transitional concurrent care, hospice providers can call 833-753-2970.

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