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University-sponsored: Medicare Advantage Enhanced Plan

The Medicare Advantage Enhanced Plan (referred to as Plan 13760 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 Enhanced 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 Enhanced 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 Enhanced Plan.

Annual deductible

Medicare Advantage Enhanced Plan - Annual deductibles, 2017

  In-network Out-of-network
Medical $0 per person
Prescription drug (does not apply to the No Rx plan) $75 per person covered by the plan


Cost of covered expenses

Medicare Advantage Enhanced Plan - Benefit coverages, 2017

  In-network Out-of-network
Primary care office visit $0
Specialist office visit $0
Inpatient hospital stay $0
Outpatient surgery $0
Ambulance service $0
Emergency room $0
Urgent care $0
Durable medical equipment $0
Lab services $0
X-ray $0
Preventive care $0


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

Out-of-pocket limit

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

Medicare Advantage Enhanced Plan - Annual out-of-pocket limits, 2017

  In-network Out-of-network
Medical $0 per person
Prescription drug (does not apply to the No Rx plan) $3,250 per person for each person covered by the plan

 

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. Although the 2017 preauthorization list is not yet available, you can access the 2016 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 February 02, 2017.