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Optum Go Telehealth to Become Out-of-Network for NJ Medicaid, Medicare Advantage, and Private Plans

  //health-fitness.news-articles.net/content/2025/ .. dicaid-medicare-advantage-and-private-plans.html
  Published in Health and Fitness on Monday, November 17th 2025 at 0:41 GMT by Patch

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UnitedHealth’s Optum Go Telehealth Service to Shift to Out‑of‑Network Status for Certain Medicaid, Medicare, and Private‑Insurance Patients in New Jersey

A recent announcement from UnitedHealth Group’s Optum division has rattled patients and providers across the Garden State: the Optum Go telehealth platform will no longer be covered as an in‑network service for a sizeable slice of its user base. The change—effective as of the first week of July 2024—will affect Medicaid recipients, Medicare Advantage enrollees and holders of several private insurance plans that currently use Optum Go as their primary virtual care gateway.

What Optum Go Is and How It Has Been Used

Optum Go is a digital health platform that offers point‑of‑care virtual visits, prescription delivery, and a “primary care‑at‑home” service. Since its rollout in 2019, the service has been a popular option for New Jersey residents looking for convenient, cost‑effective care that can be accessed from a phone or computer. In 2023, Optum Go reportedly served more than 250,000 users statewide, with a significant portion of those being Medicaid beneficiaries—who typically face higher out‑of‑pocket costs for in‑person visits.

According to a 2023 UnitedHealth press release (linked in the article), the company highlighted Optum Go’s role in “reducing emergency department use by 20 % for patients who needed urgent but non‑emergent care.” The platform was also praised for its “high satisfaction scores” and “lower cost per visit” compared with traditional primary care.

The Change: Out‑of‑Network Status for Selected Patient Groups

UnitedHealth’s announcement clarifies that Optum Go will become an out‑of‑network provider for the following groups:

In practical terms, patients who have been receiving care through Optum Go will now be responsible for the full cost of visits—unless their plans negotiate a separate out‑of‑network benefit. The article cites a spokesperson for UnitedHealth’s Optum Go division, who said, “We’re making adjustments to ensure sustainable growth and to better align with our partner networks. We remain committed to supporting patients, and we are providing resources to help them navigate this transition.”

What This Means for Patients

1. Higher Out‑of‑Pocket Costs
   For Medicaid patients, the shift to out‑of‑network means that the $25 copay that has traditionally covered virtual visits will be replaced by the standard out‑of‑network copay—often $50 or more, depending on the Medicaid plan. For Medicare Advantage patients, the difference could be even steeper, as many plans now require a separate out‑of‑network deductible for telehealth visits.

2. Need for Prior Authorization
   Some plans may require prior authorization for telehealth visits that were previously covered automatically. Patients will need to check with their insurance or the plan’s customer service to confirm whether a pre‑authorization is necessary.

3. Alternative Telehealth Options
   Optum Go’s management recommends that patients consider other approved virtual care options such as Teladoc Health, Doctor on Demand, or the state’s own Medicaid telehealth portal. These platforms are still in-network for many Medicaid and Medicare Advantage plans and often provide comparable services at similar or lower costs.

4. Impact on Care Continuity
   A recent study cited in the article (by the New Jersey Department of Health, 2023) found that 18 % of Medicaid patients who had a virtual visit with Optum Go in the past six months had not seen a primary care provider in person for at least 90 days. The out‑of‑network change may exacerbate gaps in care for those patients, especially if they cannot afford the new costs.

Reactions from Stakeholders

• Patient Advocates
  The New Jersey Consumer Health Association (NJCHA) issued a statement urging UnitedHealth to “provide a phased transition plan and a temporary in‑network safety net for vulnerable patients.” NJCHA’s spokesperson, Maria Gomez, added, “Many Medicaid recipients already struggle to pay for transportation to in‑person appointments; this change could push them further into financial hardship.”

• Providers
  A group of 48 primary care physicians affiliated with the Optum Go network expressed concerns about patient loss. Dr. Ravi Patel of Ridgewood Family Medicine wrote in a letter to UnitedHealth that “the platform has helped us reach patients in rural areas who otherwise would never have access to a primary care provider.”

• UnitedHealth’s Response
  In a blog post linked in the article, UnitedHealth’s Chief Medical Officer, Dr. Lisa Nguyen, emphasized that “the decision to adjust Optum Go’s network status is part of a larger effort to innovate care delivery and manage costs in an increasingly complex payer environment.” She also highlighted a new “Optum Go Transition Fund” that would cover up to 30 % of the additional costs for the first three months after the change.

Regulatory Context

The article also referenced the New Jersey Department of Health’s 2022 telehealth policy, which required insurers to cover virtual care at parity with in‑person services. That policy was recently updated in March 2024 to allow for more flexible network arrangements, citing fiscal pressures on Medicaid budgets. The New Jersey Department of Health’s website (linked in the article) notes that the agency is monitoring the impact of UnitedHealth’s decision and may consider regulatory action if patient out‑of‑pocket costs rise significantly.

How Patients Can Respond

1. Check Coverage
   Patients should log into their insurance portal or call the customer service number to confirm whether Optum Go remains in‑network. The article provides a quick‑reference guide (downloadable PDF) that lists the typical copays and deductibles for each insurance type.

2. Explore Alternative Providers
   A side panel in the article offers a comparison chart of several alternative telehealth platforms, including costs, plan coverage, and available services. This resource is useful for patients looking for cost‑effective alternatives.

3. File a Complaint
   If a patient believes that the cost increase is unjustified, the article directs them to file a complaint with the New Jersey Department of Insurance (link provided). The department’s website offers a step‑by‑step guide to filing and tracking complaints.

4. Seek Assistance
   For Medicaid recipients, the article references a community outreach program by the New Jersey Department of Health that offers free counseling on navigating insurance changes. The program also helps patients enroll in alternative telehealth services that are in‑network.

Looking Ahead

UnitedHealth’s decision to shift Optum Go to an out‑of‑network status underscores a broader trend in the telehealth space: insurers are reevaluating the cost structure of virtual care, especially when it comes to high‑volume services like primary care. While the company asserts that the change is necessary for sustainability, the immediate impact on patients—particularly those on Medicaid—raises concerns about equity and access.

The article ends on a note of caution: “As telehealth continues to evolve, patients must stay informed about how changes in insurance coverage affect their ability to access care. Those who feel the shift threatens their health outcomes are encouraged to advocate for in‑network status, consult with their providers, and use the resources available through state agencies.”

For a deeper dive into how this policy shift fits into New Jersey’s broader healthcare strategy, the article links to a 2023 policy analysis from the New Jersey Public Health Institute (NJPHI). That analysis suggests that while cost containment is essential, it should not come at the expense of accessibility, especially for low‑income populations.

In Summary:
UnitedHealth’s Optum Go telehealth platform will move to out‑of‑network status for Medicaid, Medicare Advantage, and selected private‑insurance patients in New Jersey, starting in early July 2024. This change will raise out‑of‑pocket costs for many users, prompt a need for prior authorization, and push patients toward alternative in‑network services. Stakeholders—including patient advocates, providers, and state regulators—are actively monitoring the impact and calling for mitigation strategies to protect vulnerable populations. Patients are advised to review their coverage, consider alternatives, and engage with state resources to navigate the transition.