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.
2025 Medicare Advantage Base Plan
About the Plan
The Medicare Advantage Base Plan features 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).
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 annual deductibles are as follows:
- Medical deductible: $300 per person
- Rx deductible: $590 (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: $3,400/person
- Rx out-of-pocket limit: $2,000
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. UnitedHealthcare requires prior authorization for physical therapy, occupational therapy, speech therapy and chiropractic services delivered in office and outpatient hospital settings, excluding home settings. Learn more about prior authorization changes for outpatient therapy services (PDF).
🏥 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)
- 2025 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
* In the event of a difference between this webpage and the plan document or summary plan description, the plan document and plan description prevail.
2024 Medicare Advantage Base Plan
About the Plan
The Medicare Advantage Base Plan features 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).
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. 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 annual deductibles are as follows:
- Medical deductible: $300 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: $3,400/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. Effective September 1, 2024, UnitedHealthcare requires prior authorization for physical therapy, occupational therapy, speech therapy and chiropractic services delivered in office and outpatient hospital settings, excluding home settings. Learn more about prior authorization changes for outpatient therapy services (PDF).
🏥 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)
- 2024 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
* 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 2024-10-21
