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UC Medicare PPO without Prescription Drugs

Administered by Anthem Blue Cross (medical) and Navitus (pharmacy)

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

It is offered to those who have Medicare-coordinated medical insurance through UC and Part D prescription drug coverage through a non-UC plan (another group health plan, former employer or individual Part D plan). You may enroll in this plan if:

  1. All covered members are enrolled in Medicare, and
  2. You provide documentation of enrollment in a creditable insurance plan that covers prescription drugs is provided. “Creditable” means your coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. (Coverage cannot be a Medicare Advantage or Medicare Advantage Prescription Drug plan.)
  • Full Full eligibility not available
  • Mid Mid eligibility not available
  • Core Core eligibility not available
  • Retirees Retirees eligibility not available

How the plan works

  • You can choose any Medicare doctor or hospital you wish.
  • Providers who accept the Medicare-allowed amount as full payment for a covered service (called “accepting Medicare assignment”) cost less. A provider who does not accept Medicare assignment can bill you for up to 15% over the Medicare allowable rate.
  • The plan covers some services that Medicare does not cover. The plan covers 80% of Anthem-allowed charges for these services. See the plan benefits booklet for more details.
  • Behavioral health services are provided by Anthem Blue Cross and Medicare. Members are covered for outpatient services not covered by Medicare from all in- and out-of-network licensed behavioral health providers, including psychiatrists, psychologists, MFTs and MFCCs. Please check with your providers to be sure they are available under this plan.

Best fit for you if:

  • You have creditable, non-UC Medicare Part D prescription drug coverage through another group health plan or an individual Part D plan that you purchased
  • You want direct access to Medicare providers without the need for referrals.
  • You are willing to pay costs for services that may vary.

Understanding your costs

UC Medicare PPO has a deductible of $100 for services not covered by Medicare. The out-of-pocket maximum for medical benefits is $1,500.

Monthly premium costs for retirees

Moving outside California?

UC offers a Medicare Coordinator Program (administered by Via Benefits) to retirees and to families whose members are all eligible for or enrolled in Medicare and live in a state outside California.