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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, which are services that the UC plan covers that Medicare either does not cover at all or for which Medicare limits have been reached.1 Except for LiveHealth online visits, you pay a $100 per person calendar-year deductible for services not covered by Medicare that are covered by Anthem. At both Anthem contracted and non-contracted providers, after you pay the deductible, the plan covers 80% of the Anthem-allowed amount.2 However, when 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. Benefits Beyond Medicare include:
    • Virtual visits with a doctor or therapist through LiveHealth Online (no deductible)
    • Behavioral health office visits from providers who opt out of Medicare
    • Inpatient hospital care beyond Medicare limits
    • Acupuncture (Note: some acupuncture services may be covered by Medicare. See the Medicare and You handbook on medicare.gov for more details.)
    • Hearing aids
    • Care when you travel outside the U.S.
    • Certain travel immunizations
    • Skilled nursing facility care beyond Medicare limits
    • Transgender surgery
  • 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.

1. Services must be medically necessary as determined by Anthem to be covered after Medicare limits are reached. Go to medicare.gov/what-medicare-covers for more information about medically necessary services.
2. The calendar-year deductible does not apply to LiveHealth Online services. However, the $20 copayment will count toward the plan’s out-of-pocket maximum.