Retiree/Survivor Health Plans
For benefit-eligible retirees and survivors, the health plan options available are determined on the eligibility and enrollment in Medicare for everyone enrolled in your university health plan.
You will want to review the appropriate section based on your individual situation.
- Medicare Enrolled - If everyone you are covering on your university health plan is eligible and enrolled in Medicare
- Pre-Medicare - If everyone you are covering on your university health plan is not eligible for Medicare
- Medicare Enrolled and Pre-Medicare - If you are covering a mixture of individuals who are eligible and enrolled in Medicare and those that are not eligible for Medicare
IMPORTANT: When making a health plan enrollment decision, you must submit your benefits enrollment changes through Wolverine Access or the paper form in the Open Enrollment retiree book you received in the mail from the University's Benefits Office.
Your address MUST be current to ensure you do not encounter delays in services or billing. Follow these steps to view or update your address:
- Visit wolverineaccess.umich.edu
- Select the ‘Employee Self Service’ tile or enter ‘Employee Self-Service’ in the search bar
- Click ‘Campus Personal Information’
- Click ‘Addresses’
- Click ‘Current Local’
- Review ‘Current Local’ address and edit if needed
Medicare Enrolled
Important Information For Retirees Enrolled in Medicare
- You may receive materials associated with your health insurance offered through the University of Michigan. For Blue Cross Blue Shield of Michigan, the information is related to Medicare Plus Blue Group PPO. For Blue Care Network, the information is related to Blue Care Network Advantage. This information is valid for your review.
For Medicare eligible retirees and survivors, enhanced Medicare Advantage Plans replaced Medicare supplemental plans January 1, 2024.
- Copays will be the same, in some cases less, than the supplemental plans
- Provides the same coverage but includes added benefits like Silver Sneakers
- Most of the providers you currently see accept Medicare Advantage, but be sure to confirm before selecting your health plan
View a chart to compare what is covered under the university's 2023 supplemental plan to what will be covered under the university's new 2024 Medicare Advantage plans. For better comparison, the chart also includes two publicly offered Medicare Advantage plans.
Services will be provided by:
- PHP - Michigan Care Advantage
- BCN - U-M Premier Care Advantage (also referred to as BCN Advantage)
- BCBS - Medicare Advantage PPO (also referred to as Medicare Plus Blue Group PPO)
View more information about the Michigan Care Advantage plan on the PHP website.
Click the following links to search the provider directories for each plan:
- Medicare Advantage PPO provider directory
- U-M Premier Care Advantage provider directory
- Michigan Care Advantage provider directory
Enrollment is based on your residential state/county. Members living in Michigan have the option to choose Michigan Care Advantage (if you live within the service area), U-M Premier Care Advantage or Medicare Advantage PPO. Members living outside of Michigan must enroll in the Medicare Advantage PPO. In addition, Medicare members must provide a residential address, not a P.O. box.
All members currently enrolled in Comprehensive Major Medical (CMM) with Medicare MUST move to one of the Medicare Advantage plans.
Members can be enrolled in only one Medicare Advantage plan. Please take the time to think about which plan to continue enrollment in.
Failure to enroll in Medicare Part A and Part B will result in disenrollment from your University of Michigan retiree health plan. In addition, there could be a penalty added to your Medicare premium.
| Plan Name | Michigan Care Advantage (PHP) | U-M Premier Care Advantage (BCN) | Medicare Advantage PPO (BCBSM) |
|---|---|---|---|
| Service Area | Includes the counties of Bay, Calhoun, Clinton, Eaton, Gratiot, Huron, Ingham, Ionia, Jackson, Kalamazoo, Livingston, Montcalm, Saginaw, Sanilac, Shiawassee, Tuscola, and Washtenaw. Use the Michigan Care eligibility tool to see if you are eligible. | Michigan | Available throughout the U.S. |
| Residency Requirement | Must live within the service area. | Must live within the service area. | Must live within the service area. |
| PCP selection required | Yes | Yes | No |
| Find a Provider | |||
| Phone Number |
844-529-3757 |
800-658-8878 |
855-669-8040 |
| Website | michigancareadvantage.com | bcbsm.com/umichmedicare/ma-plans/ | bcbsm.com/umichmedicare/ma-plans/ |
| Benefit Summary | Summary of Benefits | Summary of Benefits | Summary of Benefits |
| Plan Name | Michigan Care Advantage (PHP) | U-M Premier Care Advantage (BCN) | Medicare Advantage PPO (BCBSM) |
|---|---|---|---|
| Deductible | $0 | $0 | $0 |
| Maximum Annual Out-of-Pocket Amount | $3,000 for each individual member each calendar year | $3,000 for each individual member each calendar year | $3,000 for each individual member each calendar year |
| Preventive and Outpatient Services |
No out-of-pocket cost for preventive care. $25 copay per office visit with a primary care physician. $30 co-pay per office visit with a specialist. |
No out-of-pocket cost for preventive care. $25 copay per office visit with a primary care physician. $30 co-pay per office visit with a specialist. |
No out-of-pocket cost for preventive care. $25 copay per office visit with a primary care physician. $30 co-pay per office visit with a specialist. |
| Emergency Care |
$65 copay for emergency room visits (co-pay waived if admitted as inpatient). Ambulance covered for emergencies when medically necessary. Inpatient hospital care covered at 100%. |
$65 copay for emergency room visits (co-pay waived if admitted as inpatient). Ambulance covered for emergencies when medically necessary. Inpatient hospital care covered at 100%. |
$65 copay for emergency room visits (co-pay waived if admitted as inpatient). Ambulance covered for emergencies when medically necessary. Inpatient hospital care covered at 100%. |
| Inpatient Hospital Services | Inpatient Hospital Care - Semiprivate Room, Inpatient Physician Care, General Nursing Care, Hospital Services and Supplies (Unlimited days) are covered at 100%.
Note: Nonemergency services must be rendered in a participating hospital. |
Inpatient Hospital Care - Semiprivate Room, Inpatient Physician Care, General Nursing Care, Hospital Services and Supplies (Unlimited days) are covered at 100%.
Note: Nonemergency services must be rendered in a participating hospital. |
Inpatient Hospital Care - Semiprivate Room, Inpatient Physician Care, General Nursing Care, Hospital Services and Supplies (Unlimited days) are covered at 100%.
Note: Nonemergency services must be rendered in a participating hospital. |
| Mental Health Care |
Inpatient covered for acute conditions. Outpatient psychiatric care, group therapy and psychological testing covered; $25 copay may apply. |
Inpatient covered for acute conditions. Outpatient psychiatric care, group therapy and psychological testing covered; $25 copay may apply. |
Inpatient covered for acute conditions. Outpatient psychiatric care, group therapy and psychological testing covered; $25 copay may apply. |
| Substance Use Care |
Inpatient days of care covered. Outpatient individual and group therapy covered; $25 copay may apply. |
Inpatient days of care covered. Outpatient individual and group therapy covered; $25 copay may apply. |
Inpatient days of care covered. Outpatient individual and group therapy covered; $25 copay may apply. |
| Hearing Care |
Covers one monaural or binaural hearing aid and exam every 36 months. Hearing aids covered up to allowed amount; monaural or binaural hearing aid |
Covers one monaural or binaural hearing aid and exam every 36 months. Hearing aids covered up to allowed amount; monaural or binaural hearing aid |
Covers one monaural or binaural hearing aid and exam every 36 months. Hearing aids covered up to allowed amount; monaural or binaural hearing aid |
| Vision Care |
Eye exams covered at plan providers — one exam per year; at non-plan providers, covered up to $40. Dilation not covered. Eyeglasses not covered. |
Eye exams covered at plan providers — one exam per year; at non-plan providers, covered up to $40. Dilation not covered. Eyeglasses not covered. |
Covered; one exam per year; dilation not covered. Eyeglasses not covered. |
| Nursing Care |
Visiting nurse home care covered. Private duty nursing not covered. Home health aides covered. |
Visiting nurse home care covered. Private duty nursing not covered. Home health aides covered. |
Visiting nurse home care covered. Private duty nursing covered at 70% when medically necessary and approved by plan. Home health aides covered. |
| Other Services |
In-home hospice plus 45 days room and board covered at 100% when preauthorized. Durable medical equipment, prosthetic appliance covered when authorized by the plan. Chiropractic spinal manipulation $25 copay; manipulation services only. |
In-home hospice plus 45 days room and board covered at 100% when preauthorized. Durable medical equipment, prosthetic appliance covered when authorized by the plan. Chiropractic spinal manipulation $20 copay per office visit; manipulation services only. |
In-home hospice plus 45 days room and board covered at 100% when preauthorized. Durable medical equipment, prosthetic appliance covered when medically necessary. |
Pre-Medicare
For retirees and survivors and their covered dependents who are not eligible for Medicare, eligible retirees and survivors health plan options are the same as active employees.
Services will be provided by:
- PHP - Michigan Care
- BCN - U-M Premier Care
- BCBS - Community Blue PPO, Comprehensive Major Medical, and Consumer Directed Health Plan
Special Notes for Retirees/Survivors Considering Consumer Directed Health Plan:
- The university will not contribute to the Health Savings Account
- If you are nearing age 65 and retiring
- If you contribute to the Health Savings Account, and are nearing age 65 and enroll in Medicare Part A, please read and take action as needed regarding a conflict between IRS regulations and Medicare requirements.
- The issue: Anyone nearing age 65 who is enrolled in a qualified high-deductible health plan (Consumer Directed Health Plan) with a Health Savings Account (HSA), who enrolls in Medicare Part A, will experience a Medicare-required “look-back period” of 6 months. That “look-back period” overlaps with the timeframe during which you may have had either or both employer and employee contributions made to your HSA. IRS regulations state that an individual cannot receive or contribute to a HSA if covered by Medicare or any other health care insurance. If the individual were to be audited by the IRS, taxes and penalties could apply to the amount contributed to the HSA.
- The proposed solution: In order to avoid potential tax issues, you want to STOP YOUR HSA CONTRIBUTIONS so that you have 6 months of NO contributions before you FILE FOR MEDICARE.
| Plan Feature | Michigan Care | U-M Premier Care | BCBCM Community Blue PPO | Comprehensive Major Medical | BCBSM Consumer-Directed Health |
|---|---|---|---|---|---|
| Service Area | Limited to those who live in a specific geographical area in southeast Michigan. Access the eligibility tool. | Must live in Michigan, or within Fulton, Lucas, Williams or Wood counties in Ohio. All providers, facilities and services are rendered in Michigan. | Nationwide/Worldwide. | Nationwide/Worldwide. | Nationwide/Worldwide. |
| Network | No. | No. | Yes. | Yes. | Yes. |
| Preventive Care | No out-of-pocket cost for preventive care. | No out-of-pocket cost for preventive care. | No out-of-pocket cost for preventive care. | No out-of-pocket cost for preventive care. | No out-of-pocket cost for preventive care. |
| Deductible | No annual deductible. |
Network 1 providers: No annual deductible Network 2 providers: $2,000 individual, $4,000 family |
No annual deductible. | $500 individual, $1,000 family | $1,600 individual, $3,200 family (combined medical and Rx) |
| Out-of-Pocket Maximum | $3,000 individual, $6,000 family | $3,000 individual, $6,000 family |
In-network: $3,000 individual, $6,000 family Out-of-network: $5,000 individual, $10,000 family |
$3,000 individual, $6,000 family | $5,500 individual, $9,450 family |
| Health Savings Account | No. | No. | No. | No. | Yes. |
Medicare Enrolled and Pre-Medicare
For retirees and covered dependents who have a mixture of individuals that are eligible and enrolled in Medicare and not eligible for Medicare, the retiree will make the plan election for the member(s) that are not eligible for Medicare. The Medicare-eligible member will then be enrolled in the Medicare Advantage plan associated with the vendor for the plan that is selected.
A primary factor in the selection of the health plan will depend on your eligibility based on your current residency.
Physicians Health Plan – Michigan Care and Michigan Care Advantage
You must live in the Michigan Care service area to enroll in the Michigan Care plan. Access the Michigan Care eligibility tool.
- Medicare Enrolled Members will be in the Michigan Care Advantage plan
- Pre-Medicare Members will be in the Michigan Care plan
Blue Care Network – U-M Premier Care and U-M Premier Care Advantage
The U-M Premier Care Advantage plan is a Michigan based plan, you must reside in Michigan to enroll.
- Medicare Enrolled Members will be in the U-M Premier Care Advantage plan
- Pre-Medicare Members will be in the U-M Premier Care plan
Blue Cross Blue Shield of Michigan – Medicare Advantage PPO and Community Blue PPO; Comprehensive Major Medical; Consumer-Directed Health Plan
The Blue Cross Blue Shield of Michigan plans do not have residency restrictions within the United States.
- Medicare Enrolled Members will be in the Medicare Advantage PPO plan
- Pre-Medicare Members can be in either the:
Please refer to the 'Medicare Enrolled' and 'Pre-Medicare' charts above.