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UnitedHealthcare Community Plan QUEST Program Frequently Asked Questions

Medicaid is a program for people with low income who meet certain eligibility requirements and programs can vary from state-to-state.

To qualify for Medicaid, potential members or their children must:

  • Be a Hawai‘i resident
  • Be a U.S. citizen or a legal resident
  • Meet certain resource and income limits
  • Fit into one of these groups:
    • Parent and caretaker relatives
    • Children
    • Pregnant women
    • New adult group
    • Non-U.S. citizen needing emergency medical services
    • Children or pregnant women who are medically needy due to high medical bills

You or the member may call Customer Service toll-free at 1-888-980-8728 (TTY/TDD: 711) to request a printed copy of the formulary, or you may visit this link:  Search for drugs covered by UnitedHealthcare QUEST Program     

When applying for services, potential members will need to take or mail (if available) the following documents:

  • Pay stubs or other papers to show all family members' monthly income.
  • Social Security numbers for all individuals who want Medicaid (not required for children less than 6 months of age).
  • Papers that show family resources for all individuals who want Medicaid (for example: bank records, make, model, and year of your vehicles). This is not needed if they are applying because someone is pregnant or if they are applying only for children (age 18 or younger).
  • Legal resident papers if the potential member is not a U.S. citizen and he/she wants Medicaid for them self.
  • Proof of residence (for example: gas, electric, or water bill, letter from his/her landlord). This is not needed if applying only for children (age 18 and younger).
  • NOTE: Potential members may ask a friend or other person you choose to be their "authorized representative" to apply for him/her. He/she may also ask for a language or a sign interpreter to help him/her apply. Ask for an interpreter when calling to set up an appointment.

If a member has a medical emergency:

  • They need to get medical help as quickly as possible. Call 911 for help or go to the nearest emergency room, hospital, or urgent care center. Members don’t need to get approval or a referral first from his/her primary care provider or other plan provider. 
  • Make sure that the member’s primary care provider knows about the member’s emergency, because the primary care provider needs to be involved in following up on the member’s emergency care. The member or someone else should call to tell his/her primary care provider about the emergency care as soon as possible, usually within 48 hours

If, while temporarily outside the Plan’s service area, and the member requires urgently needed care, then the member may get this care from any provider. Members do not need a prior authorization to go to an urgent care clinic or facility. Call your PCP if you have a medical problem that is not an emergency.The plan is obligated to cover all urgently needed care at the cost-sharing levels that apply to care received within the Plan network.

A referral is from your PCP for you to see a specialist to get services. A referral is not needed when you see any specialist that is in our network that your PCP referred you to. You do not need a referral for the following services:
• Emergency Services 
• Women’s health care services, including yearly exams, pap smears, breast exams and birth control 
• Behavioral health services, such as counseling or treatment for alcohol and drug use 
• Covered family planning services

You may need approval or permission to get some services under the QUEST plan. This is called a prior authorization. Your PCP or Doctor will work with us to get prior authorization if needed.

You do not need prior authorization for emergencies or to go to an urgent care center.

You do not need it to see a women’s health provider that is not in our provider network for emergent women’s health or if you are pregnant and in your second or third trimester the day before you are enrolled with QUEST.

Learn more

UnitedHealthcare Community Plan QUEST Program


Disclaimer information
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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook. 

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 / TTY 711, or use your preferred relay service.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.