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Find support for UnitedHealthcare Individual & Family ACA Marketplace plans
Get the information and resources you need to help consumers looking to enroll in an ACA Marketplace plan. Learn about our ACA Marketplace plan options, view coverage by state, find training and more.
Explore our plan options
UnitedHealthcare ACA Marketplace plans include 5 plan types — Essential, Value, Advantage, Copay Focus, in addition to Standard plans . Each plan type offers varying coverage levels to meet all kinds of needs and budgets.
View training, education resources and more
Find information and tools to help you guide and support the people you serve.
Help consumers choose and manage their ACA Marketplace plan
Offer guidance on choosing an ACA Marketplace plan and help members understand the resources available with their plan.
See ACA Marketplace plan coverage by state
Get quick facts, find contact information and see which counties plans are available in within each state. Note that some plans may not be available in all areas and plan availability is subject to change. Confirm plan availability during the enrollment process.
Quick facts
- Non-gated EPO state, referrals not required
- Cross-border coverage in counties in Florida (Escambia, Santa Rosa), Georgia (Coweta, Muscogee, Troup), Mississippi (Clarke, George, Harrison, Jackson, Kemper, Lauderdale, Lee, Newton, Stone) and Tennessee (Bedford, Giles, Hamilton, Lawrence, Lewis, Lincoln, Marshall, Maury, Moore, Wayne)
- Pediatric dental and vision embedded in all plans
- Adult dental and vision available on select plans
- Alabama is a state that caps insulin; $0 insulin is included on all plans
Available counties
Baldwin, Barbour, Bibb, Blount, Bullock, Calhoun, Chambers, Cherokee, Chilton, Choctaw, Clarke, Clay, Cleburne, Coffee, Colbert, Conecuh, Coosa, Cullman, Dale, DeKalb, Escambia, Etowah, Fayette, Franklin, Geneva, Greene, Hale, Henry, Houston, Jackson, Jefferson, Lauderdale, Lawrence, Lee, Limestone, Macon, Madison, Marengo, Marion, Marshall, Mobile, Morgan, Perry, Pickens, Pike, Randolph, Russell, Shelby, St. Clair, Sumter, Talladega, Tallapoosa, Tuscaloosa, Walker, Washington, Winston
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Gated HMO state, referrals required
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Arizona is a state that does not impose an Insulin cap on all plans; $0 Insulin is included on all plans
- 2027 expansion into Apache, Cochise and Greenlee counties
Available counties
Apache, Cochise, Gila, Greenlee, La Paz, Maricopa, Mohave, Pima, Pinal and Santa Cruz
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- In PY2027, we will be offering additional Gated HMO plans in Phoenix (Maricopa county) that feature Sanitas Medical Center as the primary care physicians
- Members enrolled in these plans are automatically assigned to one of several Sanitas clinics and must stay within the Sanitas narrowed network to receive coverage
- Referrals may be required to see a participating specialist outside of the Sanitas clinics
- NOTE: Facilities, Specialists and Ancillary providers for this network are aligned with the broader IFP network in this area
Available counties
Maricopa
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Colorado offers multiple networks depending on which counties you live in
- Added Fremont and Pueblo counties to Valley network and Clear Creek, Park and Gilpin counties to CDP network
- Non-Gated HMO state, referrals not required
- Colorado is a state that caps Insulin; $0 Insulin is included on all plans
- Pediatric Dental and Vision are embedded on all plans
- Adult dental and vision not offered in Colorado
Network | Counties | Hospitals and Employed Providers+Key Physician Groups |
Colorado RMHP Monument One | Delta, Mesa, Moffat, Rio Blanco | Delta Health Hospital, Family Health West, Intermountain Health St. Mary’s Regional, Memorial Hospital at Craig, Pioneers Medical Center, Rangely District Hospital, Grand River Hospital Primary Care Partners, DCMH Family Medicine, Intermountain Medical Group Grand Junction, St Mary’s Family Practice, Altitude Pediatrics, Western Slope Accident Care, Family Health West Prima, Rangely Family Medicine, Meeker Family Health Center, Northwest Colorado Community Health Ctr, Colorado Surgical Affiliates, River Valley Family Health Center, Mesa Health Department, Steamboat Medical Group, Marillac Clinic, Grand River Primary Care |
Colorado RMHP Monument | Delta, Mesa, Moffat, Rio Blanco | Tier 1: Delta Health Hospital, Family Health West, Intermountain Health St. Mary’s Regional, Memorial Hospital at Craig, Pioneers Medical Center, Rangely District Hospital, Grand River Hospital District, Primary Care Partners, DCMH Family Medicine, Intermountain Medical Group Grand Junction, St Mary’s Family Practice, Altitude Pediatrics, Western Slope Accident Care, Family Health West Prima, Rangely Family Medicine, Meeker Family Health Center, Northwest Colorado Community Health Ctr, Colorado Surgical Affiliates, River Valley Family Health Center, Mesa Health Department, Steamboat Medical Group, Marillac Clinic, Grand River Primary Care Tier 2: Gunnison Valley Hospital, Montrose Memorial Hospital, Community Hospital, Southwest Memorial Hospital, Middle Park Health
|
Colorado RMHP Rocky Mountain Valley | Alamosa, Archuleta, Chaffee, Conejos, Costilla, Custer, Dolores, Eagle, Fremont, Garfield, Grand, Gunnison, Hinsdale, Huerfano, La Plata, Lake, Mineral, Montezuma, Montrose, Ouray, Pitkin, Pueblo, Rio Grande, Routt, Saguache, San Juan, San Miguel, Summit | Advent Health: AdventHealth Avista, AdventHealth Littleton, AdventHealth Parker, AdventHealth Porter, AdventHealth Castle Rock HCA HealthONE: HCA HealthONE Aurora, HCA HealthONE Centennial, HCA HealthONE Mountain Ridge, HCA HealthONE Rose, HCA HealthONE Sky Ridge, HCA HealthONE Swedish, HCA HealthONE Presbyterian St Luke’s Intermountain Health: Lutheran Hospital, Saint Joseph Hospital, St. Mary’s Regional Hospital, Good Samaritan Hospital CommonSpirit: Mercy Hospital, St. Anthony Hospital, St. Anthony North Hospital, St. Anthony Summit Hospital, St. Mary-Corwin Hospital, St. Thomas More Hospital, Longmont United Hospital, Penrose Hospital, St Francis Hospital UCHealth: Parkview Medical Center, University of Colorado Hospital, Yampa Valley Medical Center, Memorial Health System, Grandview Hospital, Pikes Peak Regional Hospital, Poudre Valley Hospital San Luis Health: San Luis Valley Health Conejos County Hospital, San Luis Valley Health Regional Medical Center Aspen Valley Hospital District, Children’s Hospital of Colorado, Community Hospital, Delta Health Hospital, Denver Health, Family Health West, Grand River Hospital District, Gunnison Valley Hospital, Middle Park Health, Montrose Memorial Hospital, National Jewish Health, Pagosa Springs Medical Center, Rio Grande Hospital, Heart of the Rockies Regional Medical Center, St. Vincent General Hospital, Southwest Memorial Hospital, Spanish Peaks Regional Health Center, Vail Health Hospital, Valley View Hospital |
Colorado Doctors Plan | Adams, Arapahoe, Boulder, Broomfield, Clear Creek, Denver, Douglas, El Paso, Elbert, Gilpin, Jefferson, Larimer, Logan, Morgan, Park, Phillips, Sedgwick, Weld | Children’s Hospital Colorado: Anschutz Medical Campus, Children’s Colorado Health Pavilion, Orthopedic Care Centennial, South Campus Highlands Ranch, Therapy Care Broomfield, North Campus Broomfield HCA HealthONE: HCA HealthONE Centennial, HCA HealthONE Aurora, HCA HealthONE Mountain Ridge, HCA HealthONE Presbyterian St. Luke’s and HCA HealthONE Rocky Mountain Children’s at Presbyterian St. Luke’s, HCA HealthONE Rose, HCA HealthONE Sky Ridge, HCA HealthONE Spalding Rehabilitation, HCA HealthONE Swedish Banner Health: East Morgan County Hospital, Banner Fort Collins Medical Center, Banner North Colorado Medical Center – Loveland Campus, Banner North Colorado Medical Center, Sterling Regional MedCenter AdventHealth: AdventHealth Avista, AdventHealth Castle Rock, AdventHealth Littleton, AdventHealth Parker, AdventHealth Porter CommonSpirit: Penrose Hospital, St. Anthony Hospital, St. Anthony North Hospital, St. Elizabeth Hospital, St. Francis Hospital, Longmont United Hospital Melissa Memorial Hospital, Haxtun Hospital District, Sedgwick County Hospital Northern Colorado Long Term Acute Hospital, Vibra Hospital of Denver, Kindred Hospital Denver, Kindred Hospital Aurora, Craig Hospital, PAM Specialty Hospital of Denver |
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Gated HMO State, referrals required
- Cross-border coverage with Alabama (Baldwin, Mobile)
- For plan year 2027, expansion into Charlotte County
- Added AdventHealth Port Charlotte, Tampa General Hospital
- Pediatric Vision embedded in all plans. Pediatric dental not available on mirrored bronze essential, standard silver, or value plans, available on all other plans
- Adult Dental and Vision available on select plans
- Florida is a state that does not impose an insulin cap on all plans; $0 Insulin is included on 1 plan on the silver metal level
Available counties
Brevard, Broward, Calhoun, Charlotte, Collier, DeSoto, Escambia, Flagler, Gadsden, Glades, Hardee, Hendry, Highlands, Hillsborough, Jefferson, Lake, Lee, Leon, Liberty, Madison, Manatee, Marion, Miami-Dade, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Seminole, Taylor, Volusia, Wakulla
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- For PY2027 we will be offering additional Gated HMO plans with a PCP capitated network in the Miami area featuring Sanitas Medical Center Primary Care Physicians exclusively in Broward, Miami-Dade and Palm Beach counties.
Members enrolled in these plans are automatically assigned to one of several Sanitas clinics and must stay within the Sanitas narrowed network to receive in network coverage.
- Referrals may be required to see a participating specialist outside of the Sanitas clinics.
- NOTE: Facilities/Health Systems for this network are the same as the broader IFP network in this area.
Available counties
Broward, Miami-Dade and Palm Beach
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated EPO State, referrals not required
- Added: Springfield Clinic Anderson Hosp, Community Hosp of Staunton, Gateway Regional Med Ctr, BJC Healthcare, WashU Physicians
- Removed due to closing: Weiss Memorial Hosp, West Suburban Med Ctr
- Cross-border coverage with Wisconsin (Kenosha, Milwaukee, Racine) with Aurora Health and cross-border coverage in Missouri (Jefferson, Ste Genevieve, St Charles, St Louis, St Louis City) with Mercy East Health System
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Illinois is a state that caps Insulin; $0 Insulin is included on all plans outside of HSA and Required plans
- Illinois has 3 total plans that are offered off-exchange only
Available counties
Bond, Calhoun, Cass, Christian, Clinton, Cook, DuPage, Effingham, Greene, Jersey, Kane, Kankakee, Kendall, Lake, Logan, Macon, Macoupin, Madison, Mason, McHenry, Menard, Monroe, Montgomery, Morgan, Randolph, Saint Clair, Sangamon, Scott, Shelby, Washington, Will
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated EPO State, referrals not required
- Entering 31 counties, total of 36 counties
- IU Health – pending signature
- No cross-border coverage
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Indiana is a state that caps Insulin; $0 Insulin is included on all plans outside of HSA and Required plans
Available counties
Blackford, Boone, Brown, Carroll, Clinton, Daviess, Decatur, Delaware, Dubois, Gibson, Hamilton, Hancock, Hendricks, Henry, Howard, Jackson, Jay, Johnson, Lawrence, Madison, Marion, Martin, Monroe, Morgan, Orange, Owen, Pike, Posey, Rush, Shelby, Spencer, Tippecanoe, Tipton, Vanderburgh, Warrick, White
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated HMO State, referrals not required
- Cross-border coverage in Missouri (Boone) and Nebraska (Burt, Cass, Dodge, Douglas, Lancaster, Otoe, Sarpy, Saunders, Thurston, Washington)
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision plans will be available at all metal levels and indicated with a “+” in the plan name
- Iowa is a state that does not impose an insulin cap on all plans; $0 Insulin is included on 1 plan on the silver metal level
- No new county expansion for plan year 2027
Available counties
Adair, Adams, Audubon, Cass, Clarke, Decatur, Fremont, Guthrie, Harrison, Mills, Montgomery, Page, Pottawattamie, Ringgold, Shelby, Taylor, Union
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated EPO State, referrals not required
- Expansion into the SW KS market plus re-entering Rating Areas 4-7. Total expansion includes all counties, with exception of Seward county.
- Cross-border coverage into Buffalo, Dundy, Franklin, Furnas, Gage, Harlan, Hitchcock, Jefferson, Lancaster, Nuckolls, Red Willow, Thayer and Webster counties in NE and Creek, Okmulgee, Osage, Pawnee, Rogers and Wagoner in OK
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Kansas is a state that does not impose an insulin cap on all plans; $0 Insulin is included on 1 plan on the silver metal level
Available counties
All counties except Seward County
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated EPO State, referrals not required
- Cross-Border coverage with Mississippi (Claiborne, Hancock, Harrison, Jefferson, Lamar, Marion, Pike, Pearl River, Warren and Walthall)
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Louisiana is a state that caps Insulin; $0 Insulin is included on all plans
Available parishes
Acadia, Ascension, Assumption, Bienville, Bossier, Caddo, Caldwell, Catahoula, Claiborne, Concordia, De Soto, East Baton Rouge, East Carroll, East Feliciana, Evangeline, Franklin, Iberia, Iberville, Jackson, Lafayette, LaSalle, Lincoln, Livingston, Madison, Morehouse, Natchitoches, Ouachita, Point Coupee, Red River, Richland, Sabine, Saint Bernard, Saint Helena, Saint James, Saint John the Baptist, Saint Landry, Saint Martin, Saint Mary, Saint Tammany, Tangipahoa, Tensas, Union, Vermilion, Washington, Webster, West Baton Rouge, West Carroll, West Feliciana
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Gated HMO State, referrals are required
- Statewide service area
- Cross-border coverage with Virginia (Arlington, Fairfax, Fairfax City, Loudoun)
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Maryland is a state that caps Insulin; $0 Insulin is included on all plans, including the state standardized plans since it is required
Available counties
All counties are covered
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Gated state, specialist referral required
- Pediatric Dental and Vision embedded in all plans
- Adult dental and vision options not available on any plans and metal levels
- Massachusetts is a state that caps Insulin; $0 Insulin is included on all plans outside of HSA and Required plans
Available counties
All counties are covered
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated HMO State, referrals not required
- Added five counties (Huron, Sanilac, St Clair, Tuscola, Lapeer) for a total of 17 counties
- Added: McLaren Health System and McKenzie Memorial Hospital
- Cross-border coverage with Ohio (Lucas) for Bon Secours Mercy Health System and , University of Toledo Medical Ctr - UTMC
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Michigan is a state that does not impose an insulin cap on all plans; $0 Insulin is included on all plans
Available counties
Branch, Calhoun, Genesee, Hillsdale, Huron, Kalamazoo, Kent, Lapeer, Macomb, Monroe, Oakland, Sanilac, Shiawassee, St. Clair, Tuscola, Van Buren, Wayne
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated HMO State, referrals not required
- Cross-border coverage with Alabama (Jefferson, Mobile, Baldwin), Louisiana (Concordia, E Baton Rouge, Franklin, Jefferson, Madison, Orleans, St Tammany, Tangipahoa, Tensas) and Tennessee (Fayette, Hardeman, McNairy, Tipton, Shelby)
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Mississippi is a state that does not impose an insulin cap on all plans; $0 Insulin is included
Available counties
Attala, Benton, Bolivar, Carroll, Chickasaw, Choctaw, Claiborne, Clarke, Clay, Coahoma, Copiah, Copiah, Covington, DeSoto, Forrest, Franklin, George, Greene, Hancock, Harrison, Hinds, Holmes, Humphreys, Issaquena, Itawamba, Jackson, Jasper, Jefferson, Jefferson Davis, Jones, Kemper, Lamar, Lauderdale, Lawrence, Leake, Lee, Leflore, Lincoln, Madison, Marion, Marshall, Monroe, Montgomery, Neshoba, Newton, Panola, Pearl River, Perry, Pike, Pontotoc, Quitman, Rankin, Scott, Sharkey, Simpson, Smith, Stone, Sunflower, Tallahatchie, Tate, Tippah, Tunica, Union, Walthall, Warren, Washington, Wayne, Webster, Winston, Yalobusha
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated EPO State, referrals not required
- Statewide coverage
- Added providers: BJC HealthCare / Barnes-Jewish Hosp, WashU Medicine
- Cross-border coverage in Illinois (Madison, Monroe, St Clair), Kansas (Atchison, Bourbon, Cherokee, Crawford, Doniphan, Jackson, Johnson, Leavenworth, Linn, Miami, Wyandotte)
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Missouri is a state that does not impose an insulin cap on all plans; $0 Insulin is included on all plans
Available counties
All counties are covered
FQHC and other Essential Community Providers
A M Med Diagnostic, Advocates For A Healthy Cmty, Affinia Healthcare, Apollo Healthcare, Arthur Ctr Cmty Hlth, Audrain Co Hlth Dept, Beyer Med Grp, BGMG, Big Springs Med Assoc, Bjk Peoples Hlth Ctrs, Bollinger Co Hlth Ctr, Bpc Steele, Burton Creek Rural Clnc, Butler Co Hlth Dept, Cape Family Med Clnc, Cape Girardeau Cnty Public Hlth Ctr RHC, CareSTL Hlth, Cedar Co Hlth Dept, Central Family & Sports Med, Central Ozarks Med Ctr, Charles Drew Hlth Ctr (FQHC), City Of Joplin, Clark Co Hlth Dept, Clay Hlth Ctr Of Ctrl Missouri, Cmty Treatment Inc., Conway Family Clnc, Co Of Lawrence, Co Of Warren, Cross Trails Med Ctr, Dallas Co Hlth Dept, Dent Co Hlth Ctr, Dixon Family Practice And Internal Med, Doctors Clnc, Douglas Co Hlth Dept, Eagleville Med Clnc, Fairfax Family Med, Family Care Hlth Ctrs, Family Practice Of Central Missouri, Family Practice Of Central Missouri - Via, Family Walk In Cln-Mountain Grove (RHC), Fcc Med Clnc, Four Rivers Cmty He, Franklin Co Hlth Dept, Freeman Clnc Of Anderson, Freeman Neosho Physician Grp, Gallatin Family Med Clnc, Gideon Med Clnc, Gilman City Med Clnc, Golden Valley Med Clinton, Golden Valley Med Osceola, Golden Valley Med Windsor, Great Mines Hlth Ctr, Hamilton Family Hlth Ctr, Hayti Med Diagnostic, HCC Network, HCCH Med Clnc, Hedrick Family Care Ctr, Hi Tech Charities, Hickory Co Hlth Dept, Hope Family Care Ctr, Infinity Hlth, Iron Co Hlth Dept, Jamesport Outreach Clnc, Jefferson Co Hlth Dept, Jefferson Med Grp Hale Clnc, Jefferson Med Grp/Carrollton RHC, Jefferson Med Grp/Norborne RHC, Jordan Valley Comm Hlth Ctr, Kansas City Care Clnc, Katy Trail Cmty Hlth, Kennett Pediatrics & Adol, Lewis Co Hlth Dept, Lincoln Co Hlth Dept, Linn Co Hlth Dept, Macon Co Hlth Dept, Mansfield Clnc (RHC), Maysville Family Hlth Clnc, Mercy Hosp Perry, Mercy Hosp Perry - RHC II, Mercy Hosp Perry - RHC III, Mercy Hosp Perry - RHCIV, Mississippi Co Hlth Dept, Mound City Family Med, NE Mo Hlth Council, Nevada Regional Primary Care Ctr, NMC Grant City Clnc, NMC New Hampton Rural Hlth Cln, North Harrison Med Clnc, Northwest Hlth Svcs, Nowcare Clnc (RHC), Oregon Co Hlth Dept, Osage Co Hlth Dept, Ottawa Family Physician, Ozark Rural Healthcare, Ozarks Cmty Hlth Ctr, Pattonsburg Med Clnc, Pemiscot Primary Care Ctr, Phelps Co Hlth Dept, Pike Co Hlth Dept, Plattsburg Family Med, PMHS Convenient Care Clnc, Polk Co Hlth Ctr, Polo Family Hlth Ctr, Preferred Family Healthcare Dba: Clarity, Prime Care Of Ava, Putnam Co Hlth Dept, Ralls Co Hlth Dept, Randolph Co Hlth Dept, Randolph Co Hlth Dept, Rich Hill Family Med Clnc (RHC), Ripley Co Public Hlth Dept, Rock Port Family Med, Saint Lukes Mercer Co Clnc, Saline Co Hlth Dept, Samuel U Rodgers Hlth Ctr, Schuyler Co Hlth Dept, Scotland Co Hlth Dept, Shelby Co Hlth Dept, South Holt Family Med, St Louis Co Dept Of Public Hlth, Ste Genevieve Co Hlth Dept, Steele Family Med, Stewartsville Med Clnc, Stone Co Hlth Dept, Sullivan Co Hlth Dept, Swope Hlth Svcs, Table Rock Family Care Clnc, Taney Co Hlth Dept, Tarkio Family Med, Texas Co Hlth Dept, The Healthy Choice, Walnut Med Clnc, Warsaw Family Clnc (RHC), Washington Co Home Hlth, Webster Co Hlth Unit, West Nodaway Family Med, Western Missouri Family & Express Care, Western Missouri Family Hlth-Concordia, Western Missouri Med Ctr, Western Missouri Women's Hlth Ctr, Westwood Rural Hlth Clnc, Wright Memorial Physicians Grp
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated EPO State, referrals not required
- Statewide coverage
- Added McCook Community Hospital
- Cross-border coverage with Iowa (Pottawattamie), Kansas (Atchison, Brown, Cheyenne, Decatur, Doniphan, Ellis, Jewell, Johnson, Leavenworth, Marshall, Miami, Nemaha, Norton, Phillips, Rawlins, Republic, Saline, Smith, Washington and Wyandotte), Missouri (Andrew, Atchison, Buchanan, Cass, Clay, Holt, Jackson, Platte) and Wyoming (Albany, Goshen and Laramie)
- Pediatric Vision and Dental available on all plans
- Adult Dental and Vision available on select plans across each metal level
- Nebraska is a state that caps Insulin medication at $35 for a 30-day supply; $0 Insulin is included on all plans
Available counties
All counties covered
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- All HPN plans are gated, referral required to see a specialist. SHL are non-gated.
- In network only
- Pediatric vision is embedded on all on exchange plans
- Pediatric dental and vision is embedded on all plans off exchange
- Adult dental and vision is offered off exchange
- Plans include $0 insulin and diabetes management services for type 1 and type 2 diabetes
Available counties
- EPO off exchange
- Clark County
- HMO on & off Exchange
- Clark County, Nye County, Washoe County
- Battle Born State Plans (On Exchange)
- Clark County, other counties in Nevada include Churchill, Douglas, Elko, Esmeralda, Eureka, Humboldt, Lander, Lincoln, Lyon, Mineral, Nye, Pershing, Storey, Washoe and White Pine
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated EPO State, referrals not required
- Statewide service area
- No cross-border coverage
- Pediatric Dental and Vision available on all plans
- Adult dental and vision not offered in New Jersey
- New Jersey is a state that caps Insulin; $0 Insulin is included on all plans outside of HSA and Required plans
Available counties
All counties covered
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated HMO State, referrals not required
- Statewide Service Area
- Cross-border coverage in Arizona (Maricopa), Colorado (La Plata) and Texas (El Paso, Lubbock, Potter)
- Pediatric Dental and Vision available on all plans
- Adult dental and vision not offered in New Mexico. New Mexico is a state that caps Insulin; $0 Insulin is included on all plans
Available counties
All counties covered
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Gated state, specialist referral required
- Pediatric Dental and Vision embedded in all plans
- Adult dental and vision options not available on any plans and metal levels
- New York is a state that caps Insulin; $0 Insulin is included on all plans outside of HSA and Required plans
Available counties
Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated HMO State, referrals not required
- No cross-border coverage
- Potential risk of ECU transitioning to out of network
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- North Carolina is a state that does not impose an insulin cap on all plans; $0 Insulin is included on all plans
Available counties
Alamance, Alexander, Bladen, Brunswick, Burke, Caldwell, Catawba, Columbus, Cumberland, Davidson, Davie, Duplin, Forsyth, Franklin, Guilford, Harnett, Haywood, Henderson, Hoke, Iredell, Jackson, Johnston, Mecklenburg, New Hanover, Orange, Pender, Randolph, Richmond, Robeson, Rockingham, Rutherford, Sampson, Scotland, Stokes, Surry, Wake, Yadkin
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated HMO State, referrals not required
- Cross-border coverage with Michigan (Monroe)
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Ohio is a state that does not impose an insulin cap on all plans; $0 Insulin is included on 2 plans on the silver metal level
Available counties
Adams, Allen, Brown, Butler, Champaign, Clark, Clermont, Clinton, Columbiana, Cuyahoga, Darke, Defiance, Erie, Franklin, Fulton, Greene, Hamilton, Hardin, Henry, Highland, Huron, Logan, Lorain, Lucas, Madison, Mahoning, Medina, Miami, Montgomery, Ottawa, Portage, Preble, Sandusky, Seneca, Shelby, Summit, Trumbull, Union, Warren, Williams, Wood and Wyandot
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated HMO State, referrals not required
- Cross-border coverage with Kansas (Barber, Chautauqua, Cherokee, Clark, Comanche, Cowley, Crawford, Finney, Ford, Meade, Montgomery, Morton, Sedwick, Seward Stevens), Missouri (Barton, Greene, Jasper, McDonald, Newton) and Texas (Childress, Clay, Collingsworth, Cooke, Dallam, Denton, Fannin, Grayson, Hansford, Hardeman, Hartley, Hemphill, Hutchinson, Lamar, Lipscomb, Montague, Moore, Ochiltree, Red River, Roberts, Sherman, Wichita, Wheeler, Wilbarger)
- Added: Integris Health (Additional hospitals added), Prague Regional Memorial Hospital, Wagoner Community Hospital
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Oklahoma is a state that caps Insulin; $0 Insulin is included on all plans
Available counties
Alfalfa, Atoka, Beaver, Blaine, Bryan, Caddo, Canadian, Cleveland, Cotton, Creek, Delaware, Dewey, Ellis, Garfield, Garvin, Grady, Grant, Greer, Harmon, Harper, Haskell, Hughes, Jackson, Jefferson, Kay, Kingfisher, Kiowa, Latimer, Lincoln, Logan, Love, McClain, McCurtain, McIntosh, Major, Marshall, Mayes, Murray, Noble, Nowata, Oklahoma, Okfuskee, Okmulgee, Osage, Ottawa, Pawnee, Payne, Pottawatomie, Pushmataha, Roger Mills, Rogers, Seminole, Tillman, Tulsa, Wagoner, Woods and Woodward
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated HMO State, referrals not required
- Exiting Cherokee, Chester, Colleton, Lancaster, Laurens, Lee, Marlboro and Union counties
- Cross-border coverage with Georgia (Richmond)
- Pediatric vision is embedded in all plans. Pediatric dental is available on all plans, except for Mirrored Bronze Essential and Mirrored Standard Silver
- Adult Dental and Vision available on select plans
- South Carolina is a state that does not impose an insulin cap on all plans; $0 Insulin is included on all plans
Available counties
Allendale, Calhoun, Clarendon, Fairfield, Hampton, Kershaw, Newberry, Saluda and Williamsburg
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated EPO State, referrals not required
- Statewide service area
- Cross-border coverage in Alabama (Colbert, Jefferson, Lauderdale, Lawrence, Limestone, Madison, Morgan) and Mississippi (Benton, DeSoto, Lee, Marshall, Tate, Tippah, Tunica, Union)
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Tennessee is a state that caps Insulin; $0 Insulin is included on all plans
Available counties
All counties covered
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Gated HMO State, referrals are required
- Total of 218 counties
- Added: Lubbock Heart Hospital, Encompass Health Rehab Hospitals
- Removed: The Physicians Centre Hospital (now BS&W)
- Cross-border access to providers in Beaver, Beckham, Bryan, Canadian, Choctaw, Cimarron, Cleveland, Cotton, Ellis, Grady, Greer, Harmon, Harper, Jackson, Jefferson, Lincoln, Logan, Love, Marshall, McClain, McCurtain, Oklahoma, Roger Mills, Texas and Tillman counties in OK
- Pediatric and adult vision and pediatric and adult dental are available
- Texas is a state that caps Insulin; $0 Insulin is included on all plans outside of HSA and Required plans
Available counties (by Market):
Amarillo
Armstrong, Briscoe, Carson, Castro, Childress, Collingsworth, Dallam, Deaf Smith, Donley, Gray, Hall, Hansford, Hartley, Hemphill, Hutchinson, Lipscomb, Moore, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Wheeler
Austin
Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis, Williamson
Beaumont
Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity, Tyler
Brownsville
Cameron, Kenedy, Willacy
College Station
Brazos, Burleson, Grimes, Leon, Madison, Milam, Robertson
Corpus Christi
Aransas, Bee, Jim Wells, Kleberg, Live Oak, Nueces, Refugio, San Patricio
Dallas/Ft. Worth
Collin, Dallas, Denton, Ellis, Erath, Hood, Hunt, Johnson, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise
El Paso
Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio
Houston
Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Waller, Walker, Wharton
Killeen-Temple
Bell, Coryell, Hamilton, Lampasas, Mills, San Saba
Laredo
Brooks, Duvall, Hidalgo, Jim Hogg, McMullen, Starr, Web, Zapata
Longview
Gregg, Harrison, Marion, Panola, Rusk, Upshur
Lubbock
Bailey, Cochran, Crosby, Dickens, Floyd, Garza, Hale, Hockley, Lamb, Lubbock, Lynn, Motley, Terry, Yoakum
Midland-Odessa
Andrews, Borden, Crane, Dawson, Ector, Gaines, Glasscock, Howard, Loving, Martin, Midland, Pecos, Reeves, Terrell, Upton, Ward, Winkler
San Angelo
Coke, Concho, Crockett, Irion, Kimble, Mason, McCulloch, Menard, Reagan, Schleicher, Sterling, Sutton, Tom Green
San Antonio
Atascosa, Bandera Bexar, Comal, Dimmit, Edwards, Frio, Gillespie, Gonzales, Guadalupe, Kendall, Kerr,Kinney, La Salle, Maverick, Medina, Real, Uvalde, Val Verde, Wilson, Zavala
Sherman-Denison
Cooke, Fannin, Grayson
Texarkana
Bowie, Camp, Cass, Delta, Franklin, Hopkins, Lamar, Morris, Red River, Titus
Tyler
Anderson, Cherokee, Henderson, Rains, Smith, Van Zandt, Wood
Victoria
Calhoun, DeWitt, Goliad, Jackson, Karnes, Lavaca, Victoria
Wichita Falls
Jack, King, Montague, Young
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- PY2027 we are again offering a gated HMO plans with a capitated network in the Houston area featuring Kelsey-Seybold clinic employed and contracted providers
- Members enrolled in these plans are automatically assigned to the clinic and must stay within the Kelsey-Seybold network to receive coverage
- Referrals may be required to see a participating specialist outside of Kelsey-Seybold clinic
- NOTE: Each Kelsey-Seybold clinic offers imaging services and they also have MRI and CT mobile units. Additional imaging services offered at participating hospitals
- NOTE: Most Kelsey-Seybold clinic locations include a participating LabCorp station
- Pediatric and adult vision and pediatric and adult dental are available on Kelsey Seybold plans
- Texas is a state that caps Insulin; $0 Insulin is included on all plans outside of HSA and Required plans
Available counties
Brazoria, Fort Bend, Galveston, Harris and Montgomery
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- PY2027 we will be offering an additional gated HMO plans with a PCP capitated network in the Houston and San Antonio areas featuring Sanitas Medical Center employed Primary Care Physicians exclusively in Bexar and Fort Bend Counties
- Members enrolled in these plans are automatically assigned to one of several Sanitas clinics and must stay within the Sanitas narrowed network to receive coverage
- Referrals may be required to see a participating specialist outside of the Sanitas clinics
- Pediatric dental and vision and Adult dental and vision available on Sanitas plans
- Texas is a state that caps Insulin; $0 Insulin is included on all plans outside of HSA and Required plans
Available counties
Bexar, Fort Bend
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated HMO State, referrals not required
- Cross-border coverage with Maryland (Frederick, Prince George, Montgomery)
- Addition of Virginia Hospital Center
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Virginia is a state that caps Insulin at $50 for a 30-day supply; $0 Insulin is included on all plans
Available counties
Alexandria City, Amelia, Arlington, Bath, Bristol city, Caroline, Charles city, Chesterfield, Clarke, Colonial Heights city, Cumberland, Dinwiddie, Fairfax, Fairfax City, Falls Church City, Fauquier, Frederick, Fredericksburg City, Goochland, Hanover, Henrico, Highland, Hopewell city, King and Queen, King George, King William, Loudoun, Louisa, Manassas City, Manassas Park City, New Kent, Petersburg city, Powhatan, Prince George, Prince William, Rappahannock, Richmond city, Scott, Spotsylvania, Stafford, Sussex, Washington, Westmoreland and Winchester City
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated EPO State, referrals not required
- Pediatric Vision available on all plans. Pediatric Dental not available
- Adult Dental and Vision not available
- Washington is a state that has $0 insulin available on all plan offerings, including HSA and Cascade (Required) plans
Available counties
Adams, Clallam, Grays Harbor, Jefferson, King, Kittitas, Lincoln, Mason, Pierce, Spokane, Thurston, Whitman and Yakima
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated HMO State, referrals not required
- Cross-border coverage with access to providers in Lake county, IL
- Added Wisconsin Independent Practice Association (WIPA)
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Wisconsin is a state that does not impose an insulin cap; $0 Insulin is included on all plans
Available counties
Brown, Door, Kenosha, Kewaunee, Manitowoc, Marinette, Milwaukee, Ozaukee, Racine, Sheboygan, Walworth, Washington and Waukesha
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday
Quick facts
- Non-Gated EPO State, referrals not required
- Cross-border coverage with Colorado (Adams, Denver, Larimer, Routt, Weld) and expansion to SD providers in Custer, Lawrence, Pennington, Meade counties and MT providers in Yellowstone county
- Pediatric Dental and Vision embedded in all plans
- Adult Dental and Vision available on select plans
- Wyoming is a state that does not impose an insulin cap on all plans; $0 Insulin is included on 1 plan on the silver metal level
Available counties
Albany, Big Horn, Campbell, Carbon, Converse, Crook, Fremont, Goshen, Hot Springs, Johnson, Laramie, Natrona, Niobrara, Park, Platte, Sheridan, Sublette, Sweetwater, Washakie and Weston
Contact us
1-866-308-4427 , TTY 711
8 a.m. to 8 p.m. local time, Monday through Friday