The monthly costs for medical coverage below apply to retirees eligible for 100 percent of the UC/employer contribution toward the premium for each plan. If you are subject to graduated eligibility and, therefore, not eligible for the maximum UC/employer contribution, your costs may be higher than those listed below. Your plan cost appears as a deduction on your UCRP benefit direct deposit statement.

When all family members are in Medicare

Medicare Plan Self in
Medicare
Self + Adult
or Self + Child(ren)
Both in
Medicare
Self + Adult + Child(ren)
All in
Medicare
Health Net Seniority Plus Your Premium $64.06 $128.11 $192.17
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00
Kaiser Permanente/
Senior Advantage
Your Premium $0.00 $0.00 $0.00
Medicare Part B
Reimbursement
$75.60 $151.21 $226.81
UC High Option
Supplement to Medicare
Your Premium $89.04 $178.07 $267.11
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00
UC Medicare PPO Your Premium $14.87 $29.73 $44.60
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00
UC Medicare PPO without Prescription Drugs Your Premium $0.00 $0.00 $0.00
Medicare Part B
Reimbursement
$121.80 $243.60 $365.40

Medicare Part B reimbursement may apply if your premium cost is $0.00. Part B reimbursement is based on a Medicare Part B premium of $121.80 per person. Reimbursements vary and are added automatically to your monthly retirement payment.

When one or more family members are not Medicare eligible

Non-Medicare/
Medicare Plans
Self + Adult
1 Adult in
Medicare
Self + Child(ren)
Adult in
Medicare
Self + Adult + Child(ren)
1 Adult in
Medicare
Self + Adult + Child(ren)
2 Adults in
Medicare
Core/
UC Medicare PPO
Your Premium $0.00 $0.00 $0.00 $0.00
Medicare Part B
Reimbursement
$121.80 $121.80 $121.80 $203.45
Health Net Blue & Gold/
Seniority Plus
Your Premium $353.67 $244.75 $534.35 $308.79
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00 $0.00
Kaiser Permanente/
Senior Advantage
Your Premium $105.31 $26.04 $206.96 $0.00
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00 $49.56
UC Care/
UC Medicare PPO
Your Premium $361.22 $236.83 $583.19 $251.70
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00 $0.00

Medicare Part B reimbursement may apply if your premium cost is $0.00. Part B reimbursement is based on a Medicare Part B premium of $121.80 per person. Reimbursements vary and are added automatically to your monthly retirement payment.

Non-Medicare Plans

Plan Self Self + Child(ren) Self + Adult Self + Adult + Child(ren)
Core $0.00 $0.00 $0.00 $0.00
Health Net Blue & Gold $225.86 $406.55 $515.47 $696.15
Kaiser Permanente — California $127.06 $228.70 $307.97 $409.62
UC Care $277.46 $499.42 $623.81 $845.78
UC Health Savings Plan $98.06 $176.51 $247.07 $325.50
Western Health Advantage $112.38 $202.28 $277.15 $367.05

Non-Medicare Plans Age 65 and over, NOT Medicare eligible

Plan Self Self + Child(ren) Self + Adult Self + Adult + Child(ren)
Core $0.00 $0.00 $0.00 $0.00
Health Net Blue & Gold $73.13 $131.63 $217.59 $276.09
Kaiser Permanente — California $53.83 $96.89 $121.24 $164.28
UC Care $124.80 $224.64 $326.11 $425.96
UC Health Savings Plan $52.98 $95.36 $119.38 $161.74
Western Health Advantage $53.83 $96.89 $121.24 $164.28

Medicare Part B reimbursement may apply if your premium cost is $0.00. Part B reimbursement is based on a Medicare Part B premium of $121.80 per person. Reimbursements vary and are added automatically to your monthly retirement payment.