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.

Changes for 2025:

Prescription drug copays will increase by $5-$15 for a 30-day supply across Tiers 1-3.
Inflation Reduction Act provisions for 2025 will cap the out-of-pocket prescription drug cost limit at $2,000 for Medicare Part D members, eliminate the coverage gap phase (or the “donut hole”), and introduce an option to pay for prescription costs in monthly installments.

Full Full eligibility not available
Mid Mid eligibility not available
Core Core eligibility not available
Retirees Retirees eligibility not available

On this page:

How the plan works
Best fit for you?
Understanding your costs
Moving outside California?

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.

Care outside the U.S.

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.

Typical out-of-pocket costs

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
- Preferred or Navitus Participating pharmacy (30-day supply): $15/$35/$50/$35
- Preferred pharmacy (90-day supply): $30/$70/$100/NA
Care outside the U.S.: You pay 20% of billed charges after a deductible of $100 per person.

UC Medicare PPO

How the plan works

Best fit for you if:

Understanding your costs in 2025

Moving outside California?

Plan documents (2025)

Plan contacts

More information