UnitedHealthcare Medicare plans will no longer be in-network with Valley Health starting October 1. If you recently received a notice in the mail about this, your access to Valley Health doctors and facilities will change. Reviewing your options now will help ensure your medical care stays fully covered.
We are Blue Ridge Agents, your local insurance advocates based right here in Winchester. We are here to help you navigate this transition and walk through all of your available coverage options. You do not have to figure out these Medicare updates by yourself.
Our team specializes in Medicare and knows the local Valley Health network inside and out. We provide straightforward, up-to-date information so you know exactly which plans cover your preferred doctors. Our goal is to give you clear answers tailored specifically to our community. Our top priority is making sure you maintain seamless access to the healthcare services and providers you rely on. Planning ahead ensures your care continues without interruption after October 1.
Below are potential coverage options for UnitedHealthcare Medicare Advantage Members:
| Coverage Option | Eligibility & Benefits | Important Details |
| Continuity of Care | For patients in active treatment, scheduled surgeries, or managing complex conditions. Keeps your Valley Health provider at in-network rates. | Requires UnitedHealthcare customer service to approve request. |
| Special Enrollment Period (SEP) | For enrollees facing significant care access disruptions. Allows switching Medicare Advantage plans or returning to Original Medicare immediately. | Coverage starts the 1st day of the next month. Call CMS at 1-800-MEDICARE (1-800-633-4227) for approval. |
| Annual Enrollment Period (AEP) | Open to all beneficiaries every year from October 15 to December 7. Allows switching plans or returning to Original Medicare. | Changes take effect January 1, 2027. Compare options at medicare.gov. |
We are here to dig into the details of these options with you and figure out if one of these applies to your specific situation.
Let's sort it out together.
FAQs
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What is changing? Valley Health facilities and physicians will no longer be in-network for UnitedHealthcare Medicare Advantage individual and group retiree plans. Continuing to see Valley Health providers under these plans after the contract ends could lead to higher out-of-pocket costs or out-of-network billing.
Why did this happen? Valley Health and UnitedHealthcare are currently negotiating new terms across all health plans. While discussions continue, an agreement has not yet been reached for commercial plans, and they have not been able to come to an agreement to renew group and individual Medicare Advantage contracts, which will end on September 30, 2026. However, both parties have agreed to extend their Medicaid contract, ensuring no disruption in coverage for UnitedHealthcare Community Plan and Complete Dual Complete members.
When does this happen? This change takes effect on October 1. Any appointments, procedures, or medical care you receive through September 30 will remain fully covered in-network as usual.
What does this mean if I have scheduled procedures? Procedures scheduled before October 1 are covered under your current in-network benefits. If you have a major procedure or ongoing treatment scheduled for after October 1, you may qualify for "Continuity of Care" protections that temporarily maintain in-network rates, or you can adjust your coverage to keep your provider.
I have a United Healthcare Medicaid plan? Am I affected? No, Dual Special Needs Plans (D-SNP) and Medicaid plans are not impacted by this change. If you are on a D-SNP plan, Valley Health will remain in-network on and after October 1.
I have a United Healthcare plan through the marketplace, or my employer, am I affected? Employer-sponsored commercial plans and Marketplace plans are currently under negotiation. While negotiations could potentially lead to network updates on October 1 if an agreement is not reached, this specific notice mainly impacts Medicare Advantage members. Additionally, Medicare Supplement plans are completely unaffected.
How can I find out what my options are? We are here to help you check your current plan, review alternative options, and figure out the best path forward for your healthcare needs. You can call Blue Ridge Agents directly at 540-431-4373 or Book A Time to schedule a quick chat with our local team.