The Medicare Advantage Base Plan 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.
Jump to: 2022 Base Plan (Group 13796) | 2021 Base Plan (Group 13759)
2022 Medicare Advantage Base Plan
About the Plan
In 2022, the Medicare Advantage Base Plan will move to an integrated Medicare Advantage plan with Part D prescription drug coverage through UnitedHealthcare, Group #13796. For complete plan details, visit the UnitedHealthcare Coverage for UM System Retirees website (exit UM System site).
Medicare Advantage Part D Transition
You may have received a Notice of Disenrollment letter from Express Scripts; please be advised that this notice is informational only. Express Scripts Medicare is required to send this notice due to the University’s Part D prescription plan moving from Express Scripts to an integrated Medicare Advantage plan with Part D prescription drug coverage through UnitedHealthcare. You are not required to take any action. All Medicare Advantage plan members will automatically be enrolled in UnitedHealthcare’s Part D prescription plan coverage effective January 1, 2022, with no break in coverage. Please see the Medicare Part D Transition Q&A (PDF) for additional information.
Costs
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💲 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. For more information about retiree insurance eligibility and premiums, visit the Retiree benefits overview webpage.
For additional details, see the SPD for this plan on the All Summary Plan Description (SPD) Documents webpage.
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 does not have an annual deductible for medical or prescription costs:
- Medical deductible: $0 per person
- Rx deductible: $0 (retail and mail-order)
🩺 Covered Services
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
Making the Most of Your Plan
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📋 Preauthorization
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.
Looking for plan providers or health care providers? Visit our plan contacts page for more information.
- Retiree Benefits Change Form - This form packet also includes the "Retiree Beneficiary Designation Information" form (for Basic Life, Additional Life, and Accidental Death and Dismemberment)
- 2022 Medicare Advantage Base Plan Summary of Benefits
- 2022 Medicare Advantage Plan Guide
- UnitedHealthcare Coverage for UM System Retirees website (exit UM System site)
- Includes Medicare Part D prescription drug information
- View all available Summary Plan Descriptions (SPDs)
- FAQs: University-sponsored Medicare Advantage plans
- Full list of forms and guides about retiree medical insurance
2021 Medicare Advantage Base Plan
Costs
Click on a header to expand the selection and uncover additional information.
💲 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)
🩺 Covered Services
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
Making the Most of Your Plan
Click on a header to expand the selection and uncover additional information.
📋 Preauthorization
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.
Looking for plan providers or health care providers? Visit our plan contacts page for more information.
- Retiree Benefits Change Form - This form packet also includes the "Retiree Beneficiary Designation Information" form (for Basic Life, Additional Life, and Accidental Death and Dismemberment)
- 2021 Medicare Advantage Base Plan Summary of Benefits
- 2021 Medicare Advantage Plan Guide
- The Summary of Benefits and Coverage (SBC) information is included in this guide. See pp. 18-41.
- 2021 Medicare Part D Prescription Drug Formulary - list of covered drugs for Express Scripts Medicare plans
- View all available Summary Plan Descriptions (SPDs)
- FAQs: University-sponsored Medicare Advantage plans
- Full list of forms and guides about retiree medical insurance
* In the event of a difference between this webpage and the plan document or summary plan description, the plan document and plan description prevail.
Reviewed 2021-11-24
