New 2025 Individual Exchange plans and prior authorization information
On Jan. 1, 2025, we’ll launch UnitedHealthcare Individual Exchange plans1 in 4 new states. We'll also continue to offer these plans in the 26 states where they currently exist. Thirteen2 of the existing states will have expanded access into 119 new counties.
New states for 2025
- Indiana
- Iowa
- Nebraska
- Wyoming
Existing states
- Alabama
- Arizona
- Colorado (Rocky Mountain Health Plans)
- Florida
- Georgia
- Illinois
- Kansas
- Louisiana
- Maryland
- Massachusetts (Navigate)
- Michigan
- Mississippi
- Missouri
- Nevada (Sierra Health and Life/Health Plan of Nevada)
- New Jersey (Oxford Metro)
- New Mexico (Choice)
- New York (Compass)
- North Carolina
- Ohio
- Oklahoma
- South Carolina
- Tennessee
- Texas
- Virginia
- Washington (Charter)
- Wisconsin
We’re excited to share that as of Jan. 1, 2025, Rocky Mountain Valley and Rocky Mountain Sky health plans and their respective provider networks will merge and expand into additional counties.3 The merged network will be called Rocky Mountain Valley.
Prior authorization information
Visit the list of codes requiring prior authorization for the new states.
Prepare for the new plans
To help ensure your practice is ready to see these members in 2025, visit our Individual Exchange plans page to access:
- The new 2025 Individual Exchange plans self-paced interactive guide
- State-specific plan information
- Coverage determination guidelines
- Medical and reimbursement policies
- Pharmacy information
- Prior authorization/notification and referral requirements
Please also prepare by:
- Sharing information with your staff about your participation and referral requirements
- In most states,4 these plans don’t require a referral from an in-network primary care provider (PCP) for a member to see a specialist5
- Members must select a PCP to help coordinate their care, or we’ll assign them a PCP after 30 days
- Modifying your business processes to recognize referral-required plans, if applicable
- Confirming that your staff has access to submit referrals and check referral statuses, if applicable
- Reviewing the prior authorization list at: Advance Notification and Clinical Submission Requirements
- Reviewing our UnitedHealthcare Individual Exchange Medical & Drug Policies and noting that we’ll conduct site of service medical necessity reviews for all procedures/codes6
Questions?
If you have questions, visit our Individual Exchange plans page, contact your provider advocate, or connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.
1Also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans.
2Thirteen expansion states: AL, AZ, CO, IL, KS, LA, MS, MO, NC, OK, SC, TX and WI.
3Expansion counties: Alamosa, Chaffee, Conejos, Custer, Huerfano, Rio Grande and Saguache.
4Except Arizona, Florida, Georgia and Texas.
5In Maryland, we’ll offer some plans that require referrals and other plans that don't require referrals.
6Except for Texas.
PCA-1-24-02332-UHN-NN_09262024
