This medical plan is a complement to your existing Medicare coverage, and you must receive services from Medicare providers.

Plan changes

Pharmacy benefits changes

Beginning Jan. 1, 2018, Anthem Blue Cross will administer pharmacy benefits for UC Medicare PPO and UC’s other preferred provider organization (PPO) medical plans, and will continue to administer medical and behavioral health benefits. The administrator of your plan processes claims, creates a network of health care providers or pharmacies and sets clinical policies and guidelines.

If you are continuing your enrollment in UC Medicare PPO, you and each of your family members will get a new ID card from Anthem Blue Cross that you can use to access medical care and behavioral health services. You will also receive an additional card for your Part D pharmacy benefit. Your Anthem Health Guide will now be able to answer questions about all of your benefits, at the same number: 844-437-0486, Monday through Friday, 5 a.m. to 8 p.m. (PT). You’ll have a new member website for all of your benefits:

UC and Anthem are working to minimize disruption during this transition. For the most part, open prescriptions will transfer automatically, and prior authorizations will remain in effect after the transition. Anthem will reach out with more information about changes that may affect you.

Still, to make sure you’re prepared for the change, it’s a good idea to:

• Refill your prescriptions before the end of the year.

• Check the Anthem formulary and prescription drug costs.

Your current covered medications will continue to be covered, but the cost of your medications may change. You may want to talk to your doctor about an alternative drug that is on the formulary to help you manage your costs.

Through the Select Generics program, generic versions of select drugs for chronic conditions will be covered with a $0 copay for members of UC High Option.

Medicare costs

Prescription Drug Part D TrOOP (True Out-Of-Pocket) costs will increase from $4,950 to $5,000. Copayments for certain services will increase slightly for low-income subsidy-eligible Medicare enrollees.

How the plan works

  • You can choose any Medicare doctor or hospital you wish; providers who accept Medicare assignment cost less.
  • Medicare pays benefits first. Then this plan calculates benefits on the Medicare allowable amount, less what Medicare paid.
  • Benefits not covered by Medicare but covered by the plan are reimbursed at 80% of customary and reasonable charges when you use an Anthem Preferred provider. See your plan booklet for details.
  • If your provider does not accept Medicare assignment, they can bill you for up to 15% over the Medicare allowable rate.
  • Behavioral health services are provided by Anthem Blue Cross and Medicare. Please check with your providers to be sure they are available under this plan.

Best fit for you if:

  • You want direct access to Medicare providers without need for referrals
  • You are willing to pay variable costs per service

Plan costs

Retiree plan costs chart »