Split-Medicare families need to enroll in corresponding partner non-Medicare and Medicare plans. You may not see the Medicare plan name when you enroll in the non-Medicare plan.
If someone in your family enrolls in a new Medicare plan, they must complete the appropriate Medicare assignment forms and mail them to the UC Retirement Administration Service Center by Nov. 27, 2023, to complete the Medicare plan enrollment.
| Non-Medicare plan | Corresponding Medicare plan | Medicare assignment form |
| UC Blue & Gold HMO | UC Medicare Choice | UBEN 121 |
| Kaiser Permanente HMO | Kaiser Permanente Senior Advantage | UBEN 127 |
| UC Care PPO | UC Medicare PPO | UBEN 123 |
| CORE PPO | UC Medicare PPO | UBEN 123 |
Please note that UC Health Savings Plan does not have a corresponding Medicare plan, and is therefore not an option for members of a split-Medicare family. If you’re a current retiree (or will retire before the next Open Enrollment) and you are enrolled in UC Health Savings Plan, you have a 31-day Period of Initial Eligibility (PIE) when you turn 65 to enroll in any of the UC-sponsored Medicare plans in your service area.
View the monthly premiums for these split-Medicare families.