Medicare Advantage Forms & Plan Information | AARP® Medicare Plans from UnitedHealthcare®
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Medicare Advantage Plans

Plan Information and Forms

Smart decisions begin with finding the right information. The resources on this page are designed to help you make good health care choices.

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AARP® MedicareComplete® insured through UnitedHealthcare premium payment forms and information

How to pay your premium

Electronic Funds Transfer (EFT) Form (PDF) (636.9 KB)
Social Security Deduction Form (PDF) (48.3 KB)



AARP MedicareComplete insured through UnitedHealthcare with Part D Prescription Coverage forms and information

OptumRx® Home Delivery
Prescription Mail Order Form - OptumRx Home Delivery (PDF)(149.1 KB)          
Prescription grievances, coverage determinations and appeals 
How to appoint a representative 
Appointment of Representative Form (PDF)
Authorization to Share Personal Information Form (PDF)(81.3 KB) - Complete this form to give others access to your account. Choose someone you trust such as a spouse, family member, caregiver or friend to access or help you manage your health plan.
Medical Reimbursement Form (PDF)(58.2 KB)

Medical Reimbursement Form – For Outside of United States and U.S. Territories (PDF)(85.6 KB)

MAPD Prescription Drug Plan - Drug Reimbursement Form (PDF)(276.4 KB)
Medication Prior Authorization Request Form (PDF) (42.1 KB)
Specialty Pharmacy Prior Authorization Request Forms
Medicare Part D Coverage Determination Request Form (PDF)(38.1 KB) - (for use by members and providers) 
Redetermination Request Form (PDF) (52.2 KB)
Medication Therapy Management (MTM) Program 
Prescription drug transition process 
Find out how to get financial help with prescription drugs



AARP MedicareComplete insured through UnitedHealthcare enrollment form

To get an AARP MedicareComplete plan enrollment form (PDF), go to View plans and pricing and enter your ZIP code. Choose one of the available plans in your area and view the plan details. You'll find the form you need in the Helpful Resources section.


Other resources and plan information:

Summary of Benefits and Evidence of Coverage - Go to View plans and pricing and enter your ZIP code. Choose one of the available plans in your area and view the plan details. You’ll find the form you need in the Helpful Resources section. 

Appeals and grievances

Commitment to quality (PDF) (218.1 KB)

UnitedHealthcare Medicare Advantage Coverage Summaries

Member rights and responsibilities

Potential for Contract Termination (PDF) (198.1 KB)

Medicare Supplement plan (Medigap) Termination Letter (PDF)(978.9 KB) - Complete this letter when a member is terminating their Medicare supplement plan (Medigap) and replacing it with a UnitedHealthcare Medicare Advantage plan.


Recursos en Español (Resources in Spanish)

To request disenrollment from your plan and switch to Original Medicare only, you have two options to choose from:

Medicare Advantage Plan Disenrollment

Medicare Advantage Prescription Drug Plan Disenrollment

Find Medicare Advantage Plans in Your Area

Example: 55105
look up ZIP code


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