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 or check.

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

$76.66 $153.32 $229.98
UC Contribution $361.34 $722.68 $1084.02
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00
Kaiser Permanente/
Senior Advantage
Your Premium $0.00 $0.00 $0.00
UC Contribution $268.76 $537.52 $806.28
Medicare Part B
Reimbursement
$92.58 $185.16 $277.74
UC High Option
Supplement to Medicare
Your Premium $126.66 $253.32 $379.98
UC Contribution $361.34 $722.68 $1084.02
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00
UC Medicare PPO Your Premium $39.66 $79.32 $118.98
UC Contribution $361.34 $722.68 $1084.02
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00
UC Medicare PPO without Prescription Drugs Your Premium $0.00 $0.00 $0.00
UC Contribution $193.00 $386.00 $579.00
Medicare Part B
Reimbursement
$134.00 $268.00 $402.00

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 $134.00 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
UC Contribution $604.50 $549.00 $752.50 $950.00
Medicare Part B
Reimbursement
$134.00 $134.00 $134.00 $164.22
Health Net Blue & Gold/
Seniority Plus
Your Premium $384.53 $269.83 $577.71 $346.50
UC Contribution $866.21 $759.25 $1,264.13 $1,120.59
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00 $0.00
Kaiser Permanente/
Senior Advantage
Your Premium $74.91 $0 $166.00 $0.00
UC Contribution $788.09 $700.94 $1,129.18 $969.70
Medicare Part B
Reimbursement
$0.00 $1.50 $0.00 $94.07
UC Care/
UC Medicare PPO
Your Premium $420.91 $286.20 $667.45 $325.86
UC Contribution $1,045.99 $890.00 $1,574.65 $1,251.34
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 $134.00 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 Your Premium $0.00 $0.00 $0.00 $0.00
UC Contribution $185.00 $333.00 $388.50 $536.50
Health Net Blue & Gold Your Premium $241.47 $434.64 $549.34 $742.52
UC Contribution $497.39 $895.30 $1,002.26 $1,400.18
Kaiser Permanente — California Your Premium $113.85 $204.93 $281.34 $372.43
UC Contribution $426.37 $767.47 $853.12 $1,194.21
UC Care Your Premium $308.17 $554.71 $689.42 $935.96
UC Contribution $660.83 $1,189.49 $1,345.48 $1,874.14
UC Health Savings Plan Your Premium $141.34 $254.41 $339.07 $452.14
UC Contribution $321.66 $578.99 $633.23 $890.56
Western Health Advantage Your Premium $128.92 $232.06 $312.99 $416.15
UC Contribution $601.81 $1,083.25 $1,221.54 $1,702.97

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

Plan Self Self + Child(ren) Self + Adult Self + Adult + Child(ren)
Core Your Premium $0.00 $0.00 $0.00 $0.00
UC Contribution $185.00 $333.00 $388.50 $536.50
Health Net Blue & Gold Your Premium $75.62 $136.11 $225.08 $285.58
UC Contribution $663.24 $1,193.83 $1,326.52 $1,857.12
Kaiser Permanente — California Your Premium $55.02 $99.04 $123.85 $167.85
UC Contribution $485.20 $873.36 $1,010.61 $1,398.79
UC Care Your Premium $142.32 $256.18 $365.16 $479.02
UC Contribution $826.68 $1,488.02 $1,669.74 $2,331.08
UC Health Savings Plan Your Premium $55.88 $100.59 $125.74 $170.43
UC Contribution $407.12 $732.81 $846.56 $1,172.27
Western Health Advantage Your Premium $55.83 $100.49 $125.62 $170.26
UC Contribution $674.90 $1,214.82 $1,408.91 $1,948.86