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 $67.41 $134.82 $202.23
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
$85.66 $171.32 $256.98
UC High Option
Supplement to Medicare
Your Premium $127.34 $254.68 $382.02
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00
UC Medicare PPO Your Premium $40.34 $80.68 $121.02
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00
UC Medicare PPO without Prescription Drugs Your Premium $0.00 $0.00 $0.00
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
Medicare Part B
Reimbursement
$134.00 $134.00 $134.00 $154.08
Kaiser Permanente/
Senior Advantage
Your Premium $88.19 $8.60 $182.45 $0.00
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00 $77.06
UC Blue & Gold/
Seniority Plus
Your Premium $368.31 $254.07 $554.97 $321.48
Medicare Part B
Reimbursement
$0.00 $0.00 $0.00 $0.00
UC Care/
UC Medicare PPO
Your Premium $465.52 $317.39 $742.57 $357.73
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 $0.00 $0.00 $0.00 $0.00
Kaiser Permanente — California $117.82 $212.08 $291.67 $385.93
UC Blue & Gold $233.33 $419.99 $534.23 $720.89
UC Care $346.31 $623.36 $771.49 $1,048.54
UC Health Savings Plan $132.92 $239.25 $323.37 $429.70
Western Health Advantage $125.75 $226.36 $308.32 $408.93

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
Kaiser Permanente — California $64.27 $115.69 $143.35 $194.77
UC Blue & Gold $86.71 $156.07 $248.55 $317.91
UC Care $214.05 $385.29 $514.52 $685.76
UC Health Savings Plan $64.83 $116.70 $144.57 $196.44
Western Health Advantage $64.56 $116.21 $143.98 $195.63