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WHAT TO DO DURING OPEN ENROLLMENT

What You Need to Know

For those enrolled in Original Medicare Parts A and B, three different UC Medicare Supplement PPO plans are available. With a Medicare Supplement plan, Medicare is your primary insurance. Your UC coverage is secondary.

When you have a Medicare-covered expense, Medicare pays its share of the cost. The UC plan then pays some or all of the remaining cost, based on the plan and the Medicare-approved amount for that service. Generally, services not covered by Medicare are not covered by the UC Medicare Supplement plans.

Consider Your Options

All UC Medicare Supplement PPO plans include:

  • Coverage for services such as doctor’s office visits, telehealth services, hospitalization, behavioral health, and coverage around the U.S. and internationally.
  • Pharmacy coverage, except for the UC Medicare PPO without Prescription Drugs plan.
  • Benefits Beyond Medicare, which covers certain services not covered by Medicare Parts A and B, such as acupuncture, hearing aids, inpatient hospital care beyond Medicare limits, and behavioral health services from providers who opt out of Medicare.
  • In-network access to expertise and the highest-quality care across the six world-class UC academic health centers.

However, there are differences between the three plans, including:

  • What you pay for coverage: Each plan has a different monthly premium. Your premium is based on the plan you choose and whether you cover any family members in addition to yourself. See what you pay for coverage each month.
  • What you pay for care (doctor’s office visits, prescriptions, etc.): The combination of your deductible plus copayments or coinsurance, up to the plan’s out-of-pocket maximum. Compare your cost for care.

UC Medicare PPO

Has a lower premium in exchange for some out-of-pocket costs for Medicare-covered services. Covers 80% of remaining costs after Medicare pays its share.

Medicare’s true out-of-pocket maximum (TrOOP) of $7,400 for prescription drugs is separate from the annual $1,500 out-of-pocket maximum for medical care.

Medicare Part D prescription drug coverage through Navitus MedicareRx includes no copayment for certain generic drugs used to treat common chronic conditions. Plus, coverage for certain lifestyle drugs, over-the-counter medications, and vitamins that Medicare Part D doesn’t cover through the UC Extra Covered Drug benefit. See the prescription drug formulary.

For details, see ucppoplans.com and the benefit summaries.

UC Medicare PPO Without Prescription Drugs

UC covers 100% of the premium for eligible retirees.

Designed for people enrolled in a prescription drug plan outside of UC, such as through a spouse, a current or former employer, or TRICARE.

Covers 80% of the remaining cost of Medicare-covered medical services after Medicare pays its share. Prescription drugs are not covered.

For details, see ucppoplans.com and the benefit summaries.

UC High Option Supplement to Medicare

Has a higher premium in exchange for no out-of-pocket costs for Medicare-covered services. Covers 100% of remaining costs after Medicare pays its share.

Has the lowest prescription drug out-of-pocket maximum ($1,000). This is separate from the annual $1,050 out-of-pocket maximum for medical care.

Medicare Part D prescription drug coverage through Navitus MedicareRx includes no copayment for certain generic drugs used to treat common chronic conditions. Plus,  for certain lifestyle drugs, over-the-counter medications, and vitamins that Medicare Part D doesn’t cover through the UC Extra Covered Drug benefit. See the prescription drug formulary.

For details, see ucppoplans.com and the benefit summaries.

Other Options

UC also offers other medical plan options for retirees on Medicare. Learn more about these options.

Compare Plans

View a side-by-side comparison [PDF] of the Medicare Supplement PPO plans.

 

MORE TO EXPLORE

Watch these videos to learn more about the Medicare PPO plans:

Medicare and Prescription Drug Coverage

UC Medicare PPO Plans Open Enrollment 2023

Compare Your Costs

What you pay for coverage depends on the plan you choose, length of employment with UC and the family members you cover.

See premiums for all plans.

Explore Providers

Medicare is your primary insurance. Your UC coverage is secondary. For the highest level of coverage, always see providers that accept Medicare. You can find participating providers at medicare.gov.

When you have a Medicare-covered expense, Medicare pays its share of the cost. The UC plan then pays some or all of the remaining cost, based on the plan and the Medicare-approved amount for that service.

The UC Medicare Supplement plans also include Benefits Beyond Medicare that covers certain services that Medicare does not cover at all, and pays for services for which Medicare limits have been reached (e.g., inpatient hospital). For these services, choose UC Health or Anthem network providers to minimize out-of-pocket costs.

Check the Boxes

During Open Enrollment:
Oct. 27 – Nov. 18, 2022

On or After Jan. 1, 2023

  • New Anthem members: Register with anthem.com/ca for the most current benefit updates, personalized claims data (including your deductible met to date), electronic ID cards, online chat with customer service, virtual care when you need it, and quick access to free health and wellness tools. (Tip: Have your member ID card handy.)
  • Register on the Navitus member portal to access your pharmacy information. You’ll also need to set up your account with Costco to use their Mail Order Pharmacy.
  • Download the Sydney Health mobile app for access to your medical plan information and wellness tools right on your mobile device. Find Sydney Health on both Google Play and the App Store.
  • Confirm your deductions are correct on your pension check.
If you changed plans for 2023

If you have a new family doctor, make an appointment for an office visit to get to know each other and to review your current health and health history. Work with your former doctor or behavioral health provider to transfer your medical records to your new doctor.

Request refills of any ongoing medication through your current plan to last through early 2023.