Members of Health Net Seniority Plus who do not take action during Open Enrollment will be enrolled automatically in UC Medicare Choice, so it's important to understand how the plans are similar and different.

Like Health Net Seniority Plus, UC Medicare Choice delivers all the benefits of Original Medicare (Parts A and B) and includes prescription drug coverage (Part D). Unlike Health Net Seniority Plus, UC Medicare Choice is a Preferred Provider Organization (PPO) plan, so you have more flexibility in choosing providers. You can seek necessary care from specialists without prior authorization from your primary care provider, and you have access to any provider, in-network or out-of-network, at the same cost to you — as long as providers accept the plan and have not opted out of or been excluded from Medicare.

The tables below highlight some differences in the benefits offered by the two plans. For a complete overview of each plan's benefits, please refer to the Evidence of Coverage documents.

UC Medicare Choice Benefit Enhancements

Benefit UC Medicare Choice HN Seniority Plus
HouseCalls $0; Annual in-home preventive care visit Not covered
Fitness Program SilverSneakers Silver&Fit
Post-Discharge Transportation
and Meal Delivery
$0; Requires case management referral
- Unlimited rides up to 30 days following discharge
- Up to 84 home-delivered meals
(3 meals/day; 1 hospitalization/yr)
Not covered
Family Support Solutions for Caregivers Not covered
Foreign Travel - Inpatient hospital: $250
- Office visit: $20
- Rx: $25 (direct member reimbursement)
Not covered
Acupuncture &
Chiropractic
(non-Medicare covered)
$20; 24 visits/yr (no network limitations) - Acupuncture: Not covered
- Chiropractic: $20; 20 visits/yr (limited network)
Hearing Aids $2,000 every 3 yrs; no hearing aid quantity limit $2,000 every 36 mos; 2 hearing aid max
Skilled Nursing Facility $0 unlimited days $0 for 100 days
Hospice $0 $20 for 1 consultation visit
Podiatry
(non-Medicare covered)
$20; 12 visits/plan year $20; 1 visit/month
Part B Drugs $0 20% coinsurance; $25/day max

 

90-day supply @ 2 copays

99.5% of pharmacies in UHC’s 90-day network 67,000

UC Walk-up or mail order only

$0 Copay List

$0 copay on select generics, vaccines, contraceptives, Part D diabetic supplies at retail/mail

Not covered

Sexual Dysfunction Drugs

Applicable copay applies (Tier 1/Tier 3); 6 pills/mo

50% coinsurance; 4 pills/mo
(8 pills/mo prior to being Medicare-eligible)


UC Medicare Choice Benefit Reductions

Benefit UC Medicare Choice HN Seniority Plus
Behavioral Health
Virtual Visits
$20 AmWell, Doctors on Demand, etc. $0 through Teladoc

Behavioral Health/Substance Abuse Group Visits

$20

$10

Partial Hospitalization for Mental Health/Substance Abuse

$20

$0

Diabetic Monitoring Supplies

UHC specifies brand coverage; 90-day transitional supply

$0; no brand restrictions
Dental Services
(Medicare covered)
$20 $0
Eyewear (Frames/Lenses;
non-Medicare covered)

Not covered

$100 every 24 months + additional coverage based on material type

Eye Exam
(non-Medicare covered)

$20; once every 12 months

$20; once every year
Foreign Travel

ER Visit: $65 (waived if admitted)
Urgent Care: $20 (waived if admitted)

ER Visit: $0
Urgent Care: $0