- Retirees
- Benefits for retirees
- Retiree health & home benefits
- Medical plans for retirees
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Which Medicare plan is right for you?
Which Medicare plan is right for you?
All of UC’s medical plans offer comprehensive coverage, but benefits and costs do vary. Check out the quick reference guide below for details.
Note: The charts below show what the member pays for care in 2024. See plan costs for your share of 2024 premium costs for retirees in UC’s Medicare and non-Medicare plans, if you are eligible for 100% of the UC employer contribution. The UC Davis Health Care Facilitator page includes a premium estimator to help you understand what your share of your retiree medical premium might be if you are not eligible for the full UC contribution.
This is a summary only. Important details — such as limitations, exclusions, exceptions and other qualifiers — may not be included. If any information on the website conflicts with plan documents, plan documents prevail.
Call the plan or see their website for specific benefits, provider information and plan booklets, or to determine if a plan provides service where you live.
Medicare retirees
Anthem Blue Cross is the medical plan administrator and Navitus is the pharmacy benefit manager of the UC Medicare PPO, UC High Option Supplement to Medicare and UC Medicare PPO without Prescription Drugs plans. UnitedHealthcare is the administrator of the UC Medicare Choice plan.
Retirees may enroll in UC Medicare PPO without Prescription Drugs only if all enrolled Medicare family members have outpatient prescription drug coverage (as verified by CMS) through another Medicare Part D prescription drug plan.
For more information on how UC-sponsored medical plans coordinate with Medicare and on “balance billing,” see UC’s Medicare Fact Sheet.
Download: Which Medicare plan is right for you? PDF
| Plan | Calendar year deductible | Annual out-of-pocket maximum: Medical benefits | Calendar year out-of-pocket maximum: Pharmacy benefits |
|---|---|---|---|
| Kaiser Permanente Senior Advantage | $0 | $1,500 per member per year | $8,000 per member |
| UC High Option Supplement to Medicare | $50 per member1 | $1,050 per member per year | $1,000 drug plan maximum out-of-pocket per member; $8,000 true out-of-pocket limit per member2 |
| UC Medicare Choice | $0 | $1,500 per member per year | $2,000 drug plan maximum out-of-pocket per member $8,000 true out-of-pocket limit per member2 |
| UC Medicare PPO | $100 per member1 | $1,500 per member per year | $8,000 per member |
| UC Medicare PPO without Prescription Drugs | $100 per member1 | $1,500 per member per year | NA |
| Plan | Hospitalization | Emergency | Medical services when traveling outside of U.S.3 |
|---|---|---|---|
| Kaiser Permanente Senior Advantage | You pay $250 copay per admittance. Medicare and plan pay the rest. | You pay $65 copay (waived if admitted). Medicare and plan pay the rest. | Emergencies/urgent care covered; inpatient care requires authorization from the plan. HMO must be notified; you may need to file for reimbursement. For other services, the plan does not pay. |
| UC High Option Supplement to Medicare | First 60 days: Plan pays Medicare Part A Deductible ($1,600 in 2023) and Medicare pays the balance. Days 61–90: Medicare pays all but $400 per day, plan pays $400 per day and you pay nothing. Days 91 and beyond4: Plan pays 80% of eligible expenses and you pay 20% of eligible expenses. | You pay nothing; Medicare and plan pay 100%. | You pay 20% of billed charges after deductible of $50 per person. |
| UC Medicare Choice | You pay $250 copay per admittance. Medicare and plan pay the rest. | You pay $65 copay (waived if admitted); Medicare and plan pay the rest. | Emergencies, urgent care and routine care covered at same copay as within U.S. |
| UC Medicare PPO | First 60 days: • Plan pays Medicare Part A Deductible ($1,600 in 2023) • Medicare pays the balance Days 61–90: • Medicare pays all but $400 per day • Plan pays 80% of $400 per day • You pay 20% ($80.00) of $400 per day Days 91 and beyond4: • Plan pays 80% of eligible expenses • You pay 20% of eligible expenses | • Medicare pays 80% • Then plan pays 80% of the eligible balance • You pay amount remaining | You pay 20% of billed charges after deductible of $100 per person. |
| UC Medicare PPO without Prescription Drugs | First 60 days: • Plan pays Medicare Part A Deductible ($1,600 in 2023) • Medicare pays the balance Days 61–90: • Medicare pays all but $400 per day • Plan pays 80% of $400 per day • You pay 20% ($80.00) of $400 per day Days 91 and beyond4: • Plan pays 80% of eligible expenses • You pay 20% of eligible expenses | • Medicare pays 80% • Then plan pays 80% of the eligible balance • You pay amount remaining | You pay 20% of billed charges after deductible of $100 per person. |
| Plan | Wellness visit | Doctor visit | Prescription drug copay |
|---|---|---|---|
| Kaiser Permanente Senior Advantage | No charge5 | • You pay $20 copay; • Medicare and plan pay the rest. | Generic/Brand Retail • Up to 30-day supply: $5/$25 • 31–60-day supply: $10/$50 • 61–100-day supply: $15/$75 Mail Order: Refills can be arranged up to 30-day supply: $5/$25; 31–100-day supply: $10/$50 |
| UC High Option Supplement to Medicare | No charge (deductible waived)5 | • Medicare pays 80% of Medicare allowable • Plan generally pays remaining 20% Example: | Tier 1/Tier 2/Tier 3/Tier 47,8 Retail (30-day supply): $10/$30/$45/$30 Mail Order (90-day supply): $20/$60/$90/NA |
| UC Medicare Choice | No charge4 | • You pay $20 copay • Medicare and plan pay the rest. | Generic/Brand/Non-Formulary Retail (up to 30-day supply): $5/$25/$40; Mail Order (31–90-day supply): $10/$50/$80; Specialty drugs • Up to 30-day supply: $25 • 31–90-day supply: $50 |
| UC Medicare PPO | No charge (deductible waived)5 | • Medicare pays 80% of Medicare allowable •Plan pays 80% of remaining eligible expenses • You pay 20% of remaining eligible expenses plus any excess charges Example: Medicare allowable6: $150 | Tier 1/Tier 2/Tier 3/Tier 4 7,8 Retail (30-day supply): $10/$30/$45/$30 Mail Order (90-day supply): $20/$60/$90/NA |
| UC Medicare PPO without Prescription Drugs | No charge (deductible waived)5 | • Medicare pays 80% of Medicare allowable • Plan pays 80% of remaining eligible expenses • You pay 20% of remaining eligible expenses plus any excess charges Example: | No prescription drug benefits |
| Plan | Mental health inpatient | Mental health outpatient | Substance abuse inpatient | Substance abuse outpatient |
|---|---|---|---|---|
| Kaiser Permanente Senior Advantage |
$250 copay per admittance; no charge for intensive outpatient and partial hospitalization | $20 for individual visit $10 for group visit | $250 copay per admittance for detoxification; $100 copayment per admission for home transitional residential recovery services; $5 per day for intensive outpatient and day-treatment programs | $20 for individual visit $5 for group visit |
| UC High Option Supplement to Medicare | You pay nothing for services provided by Medicare; otherwise you pay 20% and deductible applies. | You pay nothing for services provided by Medicare; otherwise you pay 20% and deductible applies. | You pay nothing for services provided by Medicare; otherwise you pay 20% and deductible applies. | You pay nothing for services provided by Medicare; otherwise you pay 20% and deductible applies. |
| UC Medicare Choice | $250 copay per admittance; $20 per day for intensive outpatient care and partial hospitalization | $20 (group or individual visit) | $250 copay per admittance; $20 per day for intensive outpatient care and partial hospitalization | $20 (group or individual visit) |
| UC Medicare PPO | For services covered by Medicare: • Medicare pays 80% of Medicare-allowable • Plan pays 80% of the balance • You pay any remaining balance For services not covered by Medicare, you pay 20% and deductible applies. | For services covered by Medicare: • Medicare pays 80% of Medicare-allowable • Plan pays 80% of the balance • You pay any remaining balance For services not covered by Medicare, you pay 20% and deductible applies. | For services covered by Medicare: • Medicare pays 80% of Medicare allowable • Plan pays 80% of the balance • You pay any remaining balance For services not covered by Medicare, you pay 20% and deductible applies. | For services covered by Medicare: • Medicare pays 80% of Medicare allowable • Plan pays 80% of the balance • You pay any remaining balance For services not covered by Medicare, you pay 20% and deductible applies. |
| UC Medicare PPO without Prescription Drugs | For services covered by Medicare: • Medicare pays 80% of Medicare-allowable • Plan pays 80% of the balance • You pay any remaining balance For services not covered by Medicare, you pay 20% and deductible applies. | For services covered by Medicare: • Medicare pays 80% of Medicare-allowable • Plan pays 80% of the balance • You pay any remaining balance For services not covered by Medicare, you pay 20% and deductible applies. | For services covered by Medicare: • Medicare pays 80% of Medicare allowable • Plan pays 80% of the balance • You pay any remaining balance For services not covered by Medicare, you pay 20% and deductible applies. | For services covered by Medicare: • Medicare pays 80% of Medicare allowable • Plan pays 80% of the balance • You pay any remaining balance For services not covered by Medicare, you pay 20% and deductible applies. |
| Plan | Lab work | Chiropractor | Acupuncture | Vision exams | Hearing exams / hearing aids |
|---|---|---|---|---|---|
| Kaiser Permanente Senior Advantage | No charge | $20 (manual manipulation as covered by Medicare only); covered as medically necessary when approved by a plan provider | $20; covered as medically necessary when approved by a plan provider | $20 (no charge for one Medicare-covered glaucoma screening per year) | Exam: $20 Aids: Standard hearing aids every 36 months, $2,500 maximum per ear (medically necessary) |
| UC High Option Supplement to Medicare | • You pay nothing for Medicare-approved services • Medicare pays 100% | • Medicare pays 80% of approved services (manual manipulation of the spine) • Plan pays balance • You pay nothing • You pay all costs for other services or tests | You pay 20% (deductible $50 per person) (24 visit limit/ calendar year) Note: Some acupuncture services may be covered by Medicare. See the Medicare and You handbook on medicare.gov for more details. | No charge when part of diabetes care or the Welcome to Medicare preventive visit, which must occur within the first 12 months of enrollment in Part B (coverage is for a simple vision test) | Exam: No cost after Medicare pays; for diagnostic exams if ordered by a physician Aids: 20% (maximum 2 hearing aids every 36 months, analog or digital); deductible $50 per person |
| UC Medicare Choice | No charge | $20 (24 visit limit/plan year) | $20 (24 visit limit/plan year) | $20 (no charge for one Medicare-covered glaucoma screening per year) | Exam: $20 Aids: Standard hearing aids (analog or digital) every 3 years at no charge (maximum $2,000 combined ear allowance) |
| UC Medicare PPO | • You pay nothing for Medicare-approved services • Medicare pays 100% • Diagnostic Services and X-ray have a 20% member responsibility | • Medicare pays 80% of approved services (manual manipulation of the spine) • Plan pays 80% of balance • You pay the remainder and all costs for other services or tests | You pay 20% (deductible $100 per person) (24 visit limit/calendar year) Note: Some acupuncture services may be covered by Medicare. See the Medicare and You handbook on medicare.gov for more details. | No charge when part of diabetes care or the Welcome to Medicare preventive visit, which must occur within the first 12 months of enrollment in Part B (coverage is for a simple vision test) | Exam: 20% after Medicare pays; for diagnostic exams if ordered by a physician Aids: 20% (maximum 2 hearing aids every 36 months, analog or digital); deductible $100 per person |
| UC Medicare PPO without Prescription Drugs | • You pay nothing for Medicare-approved services • Medicare pays 100% • Diagnostic Services and X-ray have a 20% member responsibility | • Medicare pays 80% of approved services (manual manipulation of the spine) • Plan pays 80% of balance • You pay the remainder and all costs for other services or tests | You pay 20% (deductible $100 per person) (24 visit limit/ calendar year) Note: Some acupuncture services may be covered by Medicare. See the Medicare and You handbook on medicare.gov for more details. | No charge when part of diabetes care or the Welcome to Medicare preventive visit, which must occur within the first 12 months of enrollment in Part B (coverage is for a simple vision test) | Exam: 20% after Medicare pays; for diagnostic exams if ordered by a physician Aids: 20% (maximum 2 hearing aids every 36 months, analog or digital); deductible $100 per person |
Definitions
Allowable Amount: The dollar amount considered payment-in-full for services provided by the health plan carrier’s network of healthcare providers. (Out-of-network providers may bill members for amounts in excess of the allowable amount.)
Annual Out-of-Pocket Maximum: The amount you must pay during the calendar year before the plan will pay 100% of covered charges (or 100% after Medicare, where applicable). Some expenses do not apply toward the maximum; see the plan’s evidence of coverage booklet.
Calendar year deductible: The calendar year deductible is the amount you must pay before the medical plan begins to pay a percentage of the total cost of benefits. Until the deductible is met, you pay the total cost of services not covered by Medicare. Review each plan’s annual deductible and monthly premium to decide which plan is best for you.
Copayments: Shown in dollars; represents the amount you pay after the deductible (if any) has been met.
Coinsurance: Shown as a percentage; represents the percentage of the allowable amount you pay after the deductible (if any) has been met.
Medicare Allowable: The Medicare-approved amount for a covered service.
Footnotes
1 Applies to certain services not covered by Medicare, called Benefits Beyond Medicare, which are services that the UC plan covers when Medicare either does not cover at all or when Medicare limits have been reached.
2 A member may reach the $8,000 True Out-of Pocket (TrOOP) before the drug plan maximum out-of-pocket if they qualify for the coverage gap discount program.
3 Consult the plan booklet or carrier for terms of coverage if your permanent address is outside the U.S.
4 Costs are different if using 60 lifetime reserve days. See plan booklet for details.
5 Medicare covers an initial “Welcome to Medicare” preventive visit and annual “Wellness” visits, where you and your doctor discuss and develop or update your personalized disease prevention plan. Note that you may be subject to copayments or coinsurance if you receive additional tests or services during the same visit that are not covered under the preventive benefits. See medicare.gov for more information on Wellness visits.
6UC Medicare PPO, UC Medicare PPO without Prescription Drugs and UC High Option Supplement to Medicare examples assume that you have met your annual deductible, and that your doctor accepts Medicare assignment. After you meet your annual out-of-pocket maximum, your plan will pay 100% of your covered expenses. Actual charges for office visits are usually higher than the Medicare allowable amount. If your doctor does not accept Medicare assignment, you are also responsible for balance billing. Call the plan for details.
7 The Navitus prescription drug formulary classifies (and charges for) medications by tier, as follows:
- Tier 1—Preferred generics and some lower-cost brand products
- Tier 2—Preferred brand products and some high-cost non-preferred generics
- Tier 3—Non-preferred products (could include some high-cost non-preferred generics)
- Tier 4—Specialty products
8 When a generic drug is available and you or your physician choose the brand-name drug, you must pay the applicable brand copay plus the difference between the cost of the brand-name drug and the generic equivalent. With prior authorization, exceptions for medical necessity can be made and you pay the Tier 3 (Non-preferred) copay.