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How the Plan Works

This is a Medicare Supplement plan. With a Medicare Supplement plan, your Medicare coverage is your primary insurance and your UC coverage is secondary. This means that when you have a Medicare-covered expense, Medicare first pays its share of the cost. Then the UC plan pays a portion, if not all, of the remaining cost based on the Medicare allowed amount for that service. Medicare determines what is covered and is medically necessary. See medicare.gov for details.

Your UC plan also pays in addition to what Medicare pays for certain services, such as inpatient hospital care, physical therapy and more. It also includes Benefits Beyond Medicare, which covers certain services not covered by Medicare Parts A & B, such as acupuncture, behavioral health services from providers who don’t accept Medicare (Medicare opt-out providers), hearing aids and more.

  • You receive the highest level of benefits when you get care from hospitals or physicians who accept Medicare. You have the option to see providers who do not accept payment from Medicare (Medicare assignment), but your out-of-pocket costs will be higher.
  • Medicare covers 100% of the cost for the Welcome to Medicare preventive visit and Annual Wellness visits. Note that Medicare does not cover what is generally known as a “physical exam.” Learn more about what preventive care services are covered by Medicare. Or for more information, go to medicare.gov.
  • When you get other types of Medicare-covered services, Anthem generally covers 80% of the remaining expenses, after Medicare pays its share.
  • The plan also pays for certain services that are not covered by Medicare, called Benefits Beyond Medicare, such as acupuncture, behavioral health from Medicare opt-out providers, hearing aids, and more.
    • You pay a $100 per person calendar-year deductible for services not covered by Medicare that are covered by Anthem.
    • Because not many behavioral health providers accept Medicare, you can choose any behavioral health provider in the Anthem network—including psychiatrists, psychologists, Marriage and Family Therapists (MFTs) and Marriage, Family and Child Counselors (MFCCs)—not just those who accept Medicare.
  • An out-of-pocket maximum of $1,500 per covered person (which includes the deductible) limits your financial liability for covered medical expenses. After you meet this amount, you get 100% coverage for most covered medical services for the remainder of the year.
    • The UC Medicare PPO has a $6,350 out-of-pocket maximum for Medicare Part D prescription drugs that is separate from (and does not count toward) the medical out-of-pocket maximum.