What You Need to Know
UC offers a range of health plan options to Medicare-eligible employees and retirees and their eligible family members.
All UC Medicare supplement plans protect your and your family’s health and include behavioral health coverage and virtual care options. Your Medicare coverage is primary. All plans also cover the Medicare Part A and Part B deductible in full. The difference among them comes down to things like how much you pay when you get care, how much you pay in paycheck contributions, and whether prescription drug coverage is included.
How it works
See the plan comparison chart [PDF] for more coverage details.
Medicare Providers
Medicare is your primary coverage. Your UC coverage is secondary. So you always want to get care from hospitals or doctors who accept Medicare. You have the option to see providers who do not accept Medicare assignment, but your out-of-pocket costs will be higher. Learn more about provider options.
No-Cost Medicare Preventive Care
When you see a provider that accepts Medicare, Medicare covers 100% of the cost (no deductible) for annual Medicare-recommended preventive screenings and lab tests based on your age and gender. While Medicare does not cover what you might think of as a physical exam, it does cover certain wellness services focused on keeping you healthy. Here’s a quick look at the types of visits and services Medicare does and does not cover, so you’ll know what services you’re getting — and what you’ll pay. For more information, go to medicare.gov.
Annual Medicare Wellness Visit
Your annual Medicare wellness visit can be in person or virtual. Talk with your doctor about the most appropriate setting for your appointment. Medicare covers most telehealth services through video and telephone.
Medicare also covers COVID-19 vaccinations and boosters. COVID-19 PCR tests are covered at no cost to you when ordered by your doctor or other health care provider. (You may have a cost for a doctor’s visit if you receive a COVID-19 test during the visit.) COVID-19 at-home tests are not covered. And flu shots are covered at no cost to you. If you haven’t received a COVID-19 vaccine or flu shot yet, talk to your doctor about the safety and effectiveness of the vaccine. Your doctor should have the latest guidelines.
If You’re New to Medicare (Part B)
What’s included in this visit?
Although this is often referred to as a physical exam, the purpose is actually to create a personalized plan and checklist for you. It may not include some of the services you received before you enrolled in Medicare, but it does include:
- A review of your medical history and your health-related social history
- Counseling about and recommendations for preventive services, screenings and immunizations
- Height, weight and blood pressure measurements
- A calculation of your body mass index (BMI)
- A simple vision test
- A review of your potential risk for depression and your level of safety
- Referrals for other care, if needed
Does Medicare cover it?
Yes. However, if your doctor recommends other screenings or tests, such as an EKG, you may have out-of-pocket costs, such as coinsurance (what you pay for covered health care services after Medicare and/or insurance pays its share).
How often can I receive this service?
Once, within your first 12 months of enrollment in Medicare Part B.
If You’ve Been a Medicare Member 12+ Months
What’s included in this visit?
During your visit,* your provider will:
- Develop or update your personalized prevention plan/checklist
- Conduct a health risk assessment
- Create/update a list of your current health care providers and medications
- Take height, weight, blood pressure and other routine measurements
- Discuss your screening schedule (checklist) for appropriate preventive services
Does Medicare cover it?
Yes. However, if your doctor recommends other screenings or tests, such as an EKG, you may have out-of-pocket costs, such as coinsurance (what you pay for covered health care services after Medicare and/or insurance pays its share).
How often can I receive this service?
Yearly, after you’ve been enrolled in Medicare Part B for longer than 12 months.
What else should I know?
You must be enrolled in Medicare Part B. You don’t need to have participated in the “Welcome to Medicare” visit to receive your yearly “Wellness” visit.
*You may not receive some of the services you received during annual physical exams before you enrolled in Medicare.
Ongoing Preventive Care
What’s included in this visit?
Services that help you stay healthy by preventing certain illnesses and health conditions, including:
- Screenings for diabetes, cardiovascular disease, depression, colorectal and lung cancer
- Mammograms
- Healthy weight counseling
Does Medicare cover it?
Yes. Medicare generally covers 100% of recommended preventive services. Check the Medicare.gov website for coverage information about specific preventive services.
How often can I receive this service?
Depends on the service. Check Medicare.gov for details.
What else should I know?
For a preventive service to be covered by Medicare, you must meet age, gender and sometimes other Medicare requirements. Check Medicare.gov for more information.
Coverage of Physical Exams
What’s included in this visit?
A physical exam and/or tests that do not directly treat an illness.
A test or screening your doctor performs during a physical exam might not be covered by Medicare as a preventive service. Before getting any recommended tests or screenings, check the Medicare.gov website for details about coverage information.
Does Medicare cover it?
No. Medicare does not cover what is traditionally known as a “physical exam.” But you can still get one and pay the full cost for the visit.
How often can I receive this service?
As often as you want. However, Medicare will likely not cover the visit.
What else should I know?
Services not covered by Medicare aren’t covered by UC either, meaning you’ll pay out of pocket for this visit. Be sure this is the visit you want before scheduling your appointment.
What You Pay for Care
Deductible
The plan covers the Medicare deductible in full. If you're using services covered by Benefits Beyond Medicare, there is a $100 deductible per individual.
Out-of-Pocket Maximum
This limits the amount you’ll pay for covered services during the year. After you meet the out-of-pocket maximum of $1,500 per covered person (which includes the deductible), you get 100% coverage for covered medical services for the remainder of the year.
Benefits Beyond Medicare
What’s Included
- Virtual visits with a doctor or therapist through LiveHealth Online (no deductible)
- Behavioral health office visits from providers who opt out of Medicare (do not participate in Medicare or do not accept Medicare payment for services)
- Inpatient hospital care beyond Medicare limits
- Acupuncture (Note: Some acupuncture services may be covered by Medicare. For details, see the Medicare and You handbook at Medicare.gov.)
- Hearing aids
- Care when you travel outside the U.S.
- Certain travel immunizations
- Skilled nursing facility care beyond Medicare limits
- Transgender surgery
Except for LiveHealth Online visits, you’ll pay your medical plan’s annual deductible for Benefits Beyond Medicare services. After you meet the deductible, the plan covers 80% of allowable charges.2 You can keep your out-of-pocket costs as low as possible by using Anthem contracted providers. Find Anthem providers by logging onto your Anthem member portal. (On your first visit, you’ll need to register.) If you see a non-contracted provider, you are responsible for paying any amount over the Anthem-allowed amount, which does not count toward the plan’s out-of-pocket maximum.
1. Services must be medically necessary as determined by Anthem to be covered after Medicare limits are reached.
2. The calendar-year deductible does not apply to LiveHealth Online services. However, the $20 copay will count toward the plan’s out-of-pocket maximum.
COVID-19 Vaccines, Tests and Treatment
See below for coverage and costs:
- COVID-19 vaccines and boosters: Covered at 100% by Medicare.
- COVID-19 PCR tests: Covered at no cost to you when ordered by your doctor or other health care provider. You may have a cost for a doctor’s visit if you receive a COVID-19 test during the visit.
- COVID-19 at-home tests: Medicare members will no longer receive free at-home tests.
- Telehealth (virtual care and video visits): Your Benefits Beyond Medicare coverage covers medical and mental telehealth and video visits through LiveHealth Online.
Source: cms.gov
Behavioral Health
You and your covered family members can use behavioral health benefits for sessions with counselors, psychologists or psychiatrists for mental health services and substance abuse treatment. If you need immediate help, call the Anthem Behavioral Health Resource Center, available 24/7 at (844) 792-5141. You can also speak to a therapist or psychologist virtually through LiveHealth Online.
Care Outside the U.S.
Access to providers for emergency and non-emergency care through the BlueCard® or Blue Cross Blue Shield Global Core network. You pay 20% of Anthem-allowed amount after the deductible. Learn more about care outside California or the U.S.
Filing Claims
When you see in-network providers for Benefits Beyond Medicare services, there are no claim forms to fill out. Your provider handles all the paperwork.
If you see an out-of-network provider for medical or behavioral health services, it's up to you to submit a claim for reimbursement for services received or prescriptions.
The easiest way to file an out-of-network claim for medical and behavioral health services is through the Anthem member portal.
Get Help
For questions about medical coverage, claims, finding providers and more, call Anthem Health Guide at (844) 437-0486 (Monday through Friday, 8 a.m. to 6 p.m. PT) or visit the Anthem member portal.
Anthem Blue Cross Life and Health Insurance Company is the claims administrator for UC PPO Plans. On behalf of Anthem Blue Cross Life and Health Insurance Company, Anthem Blue Cross processes and reviews the medical, pharmacy and behavioral health claims submitted under the plan. Anthem Blue Cross Life and Health Insurance Company is an independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Navitus is an independent company providing pharmacy benefit management services on behalf of the University of California. All plan benefits are provided by the Regents of the University of California. The content on this website provides highlights of your benefits under the UC PPO Plans. The official plan documents and administrative practices will govern in any and all cases.