Office Visit Copays Drop to $10 in 2025
Based on member feedback and Medicare Advantage savings, U-M will decrease copays for U-M Medicare Advantage plan members next year.
As of Jan. 1, 2025, office visit copays for MA plan members will be reduced to $10 per visit, including PCP, specialist, mental health care, chiropractic, and physical, occupational and speech therapies. Copays for emergency room visits will remain $65 (waived if admitted). There will be no change to copays for the prescription drug plan.
Physicians Health Plan Rebrands to University of Michigan Health Plan
Physicians Health Plan (PHP) is now University of Michigan Health Plan (UM Health Plan).
PHP is the vendor that administers Michigan Care and Michigan Care Advantage health plans. This is a name change only; your coverage remains the same. Michigan Care and Michigan Care Advantage members will receive new cards in late December.
You’ll see University of Michigan Health Plan (formerly PHP) on U-M websites, in U-M booklets and in other resources throughout Open Enrollment.
Medicare Enrolled Health Plans
Services are provided by:
- Michigan Care Advantage – Physicians Health Plan (PHP)/University of Michigan Health Plan (UM Health Plan)
- U-M Premier Care Advantage (also referred to as BCN Advantage) – BCN
- Medicare Advantage PPO (also referred to as Medicare Plus Blue Group PPO) – BCBSM
Additional Plan Details
The links below provide additional details regarding the specific plans and the benefits offered, such as Evidence of Coverage, Benefits-at-a-Glance and more:
- View more information about the Michigan Care Advantage plan on the PHP/UM Health Plan website.
- View more information about the Medicare Advantage PPO and Premier Care Advantage plans on the BCBSM website.
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 health plan. In addition, there could be a penalty added to your Medicare premium.
| Plan Name | Michigan Care Advantage (PHP/UMHealth Plan) | 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/UM Health Plan) | 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. $10 copay per office visit with a primary care physician. $10 co-pay per office visit with a specialist. |
No out-of-pocket cost for preventive care. $10 copay per office visit with a primary care physician. $10 co-pay per office visit with a specialist. |
No out-of-pocket cost for preventive care. $10 copay per office visit with a primary care physician. $10 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. |
Provider Directories
Click the following links to search the provider directories for each plan: