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University-sponsored: Medicare Advantage Base Plan

The Medicare Advantage Base Plan (referred to as Plan 13759 by Medicare) is a group plan available to Medicare-eligible retirees and their dependents. However, if you are a pre-1990 retiree who never enrolled in Medicare due to your pre-1990 status, or are a Federal Civil Service retiree and are not eligible for Medicare, you will have the same plan options as retirees or dependents that are not Medicare eligible. Those plan options are listed on the retiree benefits overview webpage.

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Monthly premiums

Your share of insurance premiums is determined by a formula that considers your age and years of service at retirement and the program under which your benefits are payable. If you are looking for an idea of what premiums would be for your particular circumstances, use the Retiree Insurance Premiums Estimator. For additional details, see the Summary Plan Description for the university-sponsored Medicare Advantage Base Plan under the forms and guides section of this page.

Note: You still need to pay your Original Medicare Part B premiums, in addition to the premiums for the university-sponsored Medicare Advantage Base Plan. In most cases, there is no premium requirement for Original Medicare Part A. If, however ,you are not eligible for no-cost Medicare Part A coverage and are paying for this coverage, you are required to continue to pay this premium when enrolled in the university-sponsored Medicare Advantage Base Plan.

Annual deductible

The Medicare Advantage Base Plan has two annual deductibles: one for medical and a second for prescription drug costs.

  • Medical deductible: $0 per person
  • Rx deductible: $200 (retail only)

Cost of covered expenses

What you pay for covered expenses is as follows:

  • Primary care office visit: $10
  • Specialist office visit: $20
  • Inpatient hospital stay: $200/admittance
  • Outpatient surgery: $100
  • Ambulance service: $50
  • Emergency room: $65
  • Urgent care: $35
  • Durable medical equipment: 20% coinsurance
  • Lab services X-ray: $0 outpatient; $25 diagnostic
  • Preventive care: $0

*For a full schedule of benefit coverages, refer to the UnitedHealthcare (UHC) Medicare Advantage Plan Guide.

Out-of-pocket limit

The university-sponsored Medicare Advantage Base Plan has two annual out-of-pocket limits: one for medical and a second for prescription drug costs.

  • Medical out-of-pocket limit: $2,000/person
  • Rx out-of-pocket limit: $4,130


In some cases, prior authorization is necessary for non-emergency use of certain facilities, diagnostic testing, and other health services before care is provided. You can access the preauthorization list for active employees (PDF, 14KB) to see a similar list of services/treatments.

Network providers

As long as your doctor, hospital, or other provider participates in (i.e., accepts payment from) Medicare, you will receive the same level of coverage whether or not your provider is a member of the UHC Group National PPO Network. The university-sponsored group Medicare Advantage Base Plan and Medicare Advantage Enhanced Plan provide the flexibility to see providers in or out of network at the same cost.

Forms and guides

* In the event of a difference between this webpage and the plan document or summary plan description, the plan document and plan description prevail.

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Reviewed 2021-07-02