UC Medicare PPO
Administered by Anthem Blue Cross (medical) and Navitus (pharmacy)
This medical plan is a complement to your existing Medicare coverage; you must receive services from Medicare providers.
- Full Full eligibility not available
- Mid Mid eligibility not available
- Core Core eligibility not available
- Retirees Retirees eligibility not available
How the plan works
You can choose any Medicare doctor or hospital you wish; providers who accept Medicare assignment cost less. If your provider does not accept Medicare assignment, they can bill you for up to 15% over the Medicare allowable rate.
The plan covers some services that Medicare does not cover (called Benefits Beyond Medicare). The plan covers 80% of Anthem-allowed charges for these services. See the plan benefits booklet for more details.
Behavioral health services are provided by Anthem Blue Cross and Medicare. Members are 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.
See updated information about coverage for COVID tests.
Before you travel, call the Anthem Health Guide to learn about your benefits outside of the United States, Puerto Rico, and U.S. Virgin Islands, provided through the Blue Cross Blue Shield Global Core® Program.
If you need assistance while you’re out of the country, the Global Core service center is available 24 hours a day, seven days a week at (800) 810-BLUE (2583), or you can call them collect at (804) 673-1177. Keep your ID card handy (in your wallet or on your phone) when you travel to help you get the care you need.
Best fit for you if:
- You want direct access to Medicare providers without the need for referrals.
- You are willing to pay costs for services that may vary.
Understanding your costs
UC Medicare PPO has a deductible of $100 for services not covered by Medicare. The out-of-pocket maximum for medical benefits is $1,500.
- Wellness visit: no charge
- Office and emergency room visits: Medicare pays 80% of Medicare allowable charges and the plan pays 80% of remaining eligible expenses. That means you pay 20% of the remaining eligible expenses plus any excess charges. For example, for a $150 visit, Medicare would pay $120, your plan would pay $24 and you would pay $6.
- Emergency room visits: $65
- Hospital stay:
- First 60 days: Your plan pays the Medicare Part A Deductible and Medicare pays the balance.
- Days 61–90: Medicare pays all but $400 per day. Your plan pays 80% of $400 per day and you pay 20% ($80.00).
- Days 91 and beyond: Your plan pays 80% of eligible expenses and you pay 20% of eligible expenses.
- Prescription drugs: Tier 1/Tier 2/Tier 3/Tier 4
- Retail (30-day supply): $10/$30/$45/$30
- Mail Order (90-day supply): $20/$60/$90/NA
- Care outside the U.S.: You pay 20% of billed charges after a deductible of $100 per person.
Moving outside California?
UC offers a Medicare Coordinator Program (administered by Via Benefits) to retirees and to families whose members are all eligible for or enrolled in Medicare and live in a state outside California.
Plan documents
Plan contacts
- UC Health Plans website
- Anthem Health Guide: 844-437-0486
- Anthem Behavioral Health: 844-792-5141
- Navitus Medicare Rx: 833-837-4309