UnitedHealthcare Choice Plus vs Navigate
Choice Plus and Navigate are two ways of organizing care. One lets employees go straight to network specialists, the other builds care around a primary care physician. The right one depends on how your employees use care and what they will accept.
Choice Plus and Navigate side by side
Choice and Choice Plus
Members can see network physicians and specialists without a referral. Choice Plus also covers out-of-network care at a higher cost to the member.
Navigate
Navigate, Navigate Balanced and Navigate Plus coordinate care through a primary care physician, with referrals required for benefits in the base plan.
How we decide
Employees who want freedom
Groups that will not accept referrals usually do better on Choice or Core.
Employers who want care coordination
Navigate suits groups that value a primary care physician guiding care.
Cost Pressure
Coordinated designs are typically priced differently from open-access ones. We price both on your census.
An illustration of how this plays out
This is a composite example to show the reasoning, not a description of a specific client.
The situation
An employer was split between employees who wanted to see specialists directly and a leadership team focused on cost.
What we did
We priced a Choice-style open-access design and a Navigate-style coordinated design on the same census.
What changed
The group saw the actual cost of open access, and chose with that number in front of them rather than a general sense that coordinated care costs less.
How to decide between open access and coordinated care
How do your employees use specialists?
Heavy specialist use favors open access.
How strongly does your workforce value choice?
Resistance to referrals shows up quickly at open enrollment.
What does the price gap look like?
Price both on the same census before deciding.
Can you explain it clearly?
Either design needs a plain explanation at enrollment.
Deciding between freedom and coordination.
The trade-off is about control. Open access gives employees the freedom to go directly to a specialist and often comes with a higher premium. A coordinated design asks employees to start with a primary care physician and can lower cost, but requires them to follow a referral process. Which one works depends on what your employees will accept.
Ask a few direct questions before deciding. How often do employees see specialists? Do they already have a primary care physician? Would a referral requirement lead to complaints? The answers often make the choice obvious. Confirm benefit details and referral rules in the plan documents before you finalize.
Questions we get
Does Choice Plus cover out-of-network care?
Yes, at a higher cost to the member than network care.
Do Navigate members need referrals?
Referrals are required for specialist benefits in the base plan.
Which is cheaper?
It depends on your census and region. We price both.
Can we offer both?
Some employers offer more than one design. That adds complexity and splits the risk pool, so we model it first.
Do referrals slow care down?
It depends on the practice and the plan. We ask how referrals work in your area.
Can an employer offer both designs?
Many employers do, with different employee contributions. Ask the carrier about requirements for offering multiple plans.
How do employees without a primary care physician fare in a coordinated plan?
They generally need to select one. Plan your communication so employees can choose before open enrollment ends.
The law behind this page.
Public Health Service Act section 2715 (42 U.S.C. § 300gg-15), Summary of Benefits and Coverage; Michigan Department of Insurance and Financial Services.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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