This medical plan is a complement to your existing Medicare coverage, and you must receive services from Medicare providers.
2017 changes: Anthem Blue Cross has replaced Blue Shield of California as the administrator of medical and behavioral health benefits for UC's PPO plans (including UC Medicare PPO). OptumRx has replaced Blue Shield as the administrator of prescription drug benefits. For more information, see our transition checklist.
You will receive separate ID cards for your medical and pharmacy benefits; Anthem Blue Cross and OptumRx have begun mailing 2017 ID cards. You may also print a copy of your ID card from the Anthem or OptumRx website or call Anthem (844-437-0486) or OptumRx (855-489-0651) to request your ID number.
How the plan works
- You can choose any Medicare doctor or hospital you wish; providers who accept Medicare assignment cost less.
- Medicare pays benefits first. Then this plan calculates benefits on the Medicare allowable amount, less what Medicare paid.
- Benefits not covered by Medicare but covered by the plan are reimbursed at 80% of customary and reasonable charges when you use an Anthem Preferred provider. See your plan booklet for details.
- If your provider does not accept Medicare assignment, they can bill you for up to 15% over the Medicare allowable rate.
- Behavioral health services are provided by Anthem Blue Cross and Medicare. Beginning in 2017, members will be covered for outpatient services not covered by Medicare from all in- and out-of-network licensed behavioral health providers, including psychiatrists, psychologists, MFTs and MFCCs. Please check with your providers to be sure they are available under this plan.
Best fit for you if:
- You want direct access to Medicare providers without need for referrals
- You are willing to pay variable costs per service