UNITEDHEALTHCARE INSURANCE COMPANY

What the CMS Data Shows About UNITEDHEALTHCARE INSURANCE COMPANY

UNITEDHEALTHCARE INSURANCE COMPANY operates under CMS contract H1537, issued by UnitedHealthcare (parent organization UnitedHealth Group, Inc.). The contract is classified as a Local PPO product, which governs how enrollees access care: PPO designs let members see out-of-network providers at higher cost-sharing, giving broader access than an HMO. This contract is also flagged in CMS data as a Special Needs Plan (SNP), meaning enrollment is restricted to beneficiaries meeting specific eligibility criteria — chronic condition, dual Medicare-Medicaid status, or institutional residence. Service area spans 50 states (AL, AR, AZ, CA, CO, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VI, VT, WA, WI, WV, WY) and more than 40 counties, a geography set at the CMS service-area definition level.

The overall CMS Star Rating for this contract is 4.5 out of 5.0. This rating synthesizes 34 individual quality measures spanning 8 CMS domains, including clinical outcomes, patient experience (CAHPS), member complaints and appeals, and plan operations. The Part D drug-benefit portion of this contract carries a separate CMS Star Rating of 4.5, which reflects pharmacy cost, adherence to chronic medications, and drug pricing accuracy. Ratings at 4+ stars trigger federal Quality Bonus Payments that insurers typically reinvest in supplemental benefits.

On costs, this contract lists a monthly plan premium of not reported. Supplemental-benefit detail is not available in the public file for this contract. Before enrolling, verify that your preferred providers participate in the plan's network for your specific county, review the current Summary of Benefits, and confirm that your prescriptions appear on the plan formulary. All figures shown come from CMS public-use files for the 2026 contract year; this page is informational only and is not personalized Medicare counseling advice.