Medicare Advantage Frequently Asked Questions

Find answers to questions regarding:

The U-M Plans

Why is it so important for U-M to have my physical address and not my P.O. box?
The Centers for Medicare and Medicaid Services (CMS) validates enrollment for individuals moving into a Medicare Advantage plan. The validation process requires that we have the physical residency for each participant. For this reason, please make sure your home address is up-to-date in Wolverine Access.
Where can I get more information about Open Enrollment and U-M Medicare Advantage Plans?
The U-M Benefits Office team will host two free webinars about Open Enrollment benefits for retirees in October. View the Open Enrollment web page to register and get more information.
Check the Open Enrollment web page, Retiree/Survivor/LTD Participant health plan web page,  UHR News and your U-M email account frequently for the latest news. 
Are U-M’s Medicare Advantage plans the same as the publicly available Medicare Advantage plans I’ve read about in articles, such as in The New York Times, or have seen advertised?
No. U-M’s Medicare Advantage plans are not the same as publicly offered plans. They are intentionally distinct, with lower out-of-pocket costs, from the consumer plans available to the general public.
The U-M MA plans were custom-designed by the university with the involvement of faculty experts and Michigan Medicine leadership to provide more benefits and lower out-of-pocket costs than the publicly available plans. To be eligible to enroll in U-M’s MA plans, you must be a benefits-eligible retiree from the University of Michigan and enrolled in Medicare Parts A and B. The general public is not eligible for U-M’s MA plans.
Do U-M Medicare Advantage plans require members to pay a deductible?
No. There are no deductibles for any U-M Medicare Advantage plan.
What are U-M Medicare Advantage plan copays?
As of Jan. 1, 2025, all office visit copays for U-M Medicare Advantage plans are $10 per visit, including for primary care physician (PCP), specialist, mental health, chiropractic, and physical, occupational and speech therapy care. Copays for emergency room visits are $65 (waived if admitted).
Do I have an out-of-pocket maximum with U-M Medicare Advantage plans?
The out-of-pocket maximum for all Medicare Advantage plans is $3,000. Fixed copays for select services are stated in the benefit summaries. These copays are tracked; when you have paid $3,000 in copays, you will not have further copays for the rest of the year. This out-of-pocket maximum has been in place since 2014.
When I switch to Medicare Advantage, can I continue to see my primary care physician (PCP)?
It depends on whether the provider is a participating provider in your selected Medicare Advantage plan.
The U-M Premier Care Advantage plan requires a PCP selection; the Medicare Advantage PPO plan does not. If you are enrolled in one of the HMO plans, contact the health plan to confirm your PCP selection. If a member in a HMO plan has not selected a PCP, one will be selected for them. The member will receive a letter stating the selected PCP. You may still change your PCP by contacting the health plan.
Are there changes in prior authorization with the U-M Medicare Advantage plans? 
U-M Medicare Advantage plans use the same prior authorization processes as the plans for active faculty and staff.
Prior authorization is between the provider and the health plan. The patient does not have a role in seeking prior authorization. Additionally, the Centers for Medicare and Medicaid Services (CMS), a federal agency, sets regulations as to how plans handle prior authorization. A plans’ medical necessity guidelines cannot be more stringent than CMS guidelines.
In instances when approval did not go through or was declined, we usually found that the provider had not provided medical documentation that needed to be submitted or that there had been a missed step (for example, the patient needed blood work before having an MRI approved). Most denials were temporary while awaiting additional documentation from the provider to support the requested service.
How does prior authorization with U-M Medicare Advantage plans compare with other MA plans?
U-M MA plans have a better rate of approval than other plans.
A recent Kaiser Family Foundation article mentions that publicly available Medicare Advantage plans have prior authorization denial rates between 3-12% or approval rates averaging between 88% - 97%. This article does not refer to the U-M MA plans. 
U-M Benefits Office has been monitoring this with our health plans and, in the first five months of 2024, U-M plans have a 98.5% approval rate, which is better than the publicly available MA plans published in the Kaiser article. The U-M Benefits Office continues to monitor members' experiences with prior authorizations and will address concerns with the health plans as needed.
Do I need to change my Durable Medical Equipment (DME) provider?
It depends on whether the DME provider is a participating provider in your selected Medicare Advantage plan. Ask your current DME provider if they are participating with the health plan you are enrolled in. If you have questions about a network provider, contact the health plan using the customer service number on the back of your ID card.
What are the residency requirements for each Medicare Advantage plan?
Blue Cross Blue Shield of Michigan's (BCBSM) Medicare Advantage PPO plan requires that you live within the U.S.
Blue Care Network's U-M Premier Care Advantage includes all counties in Michigan EXCEPT (limited access in) Alger, Baraga, Cass, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keweenaw, Marquette, Menominee and Ontonagon. If you live in one of the above counties, please select the BCBSM Medicare Advantage PPO plan. 
I had a recent claim/service denied that historically had been covered. Why did this happen?
One possible reason that claims or services might be denied is that the provider is not using  your new ID card contract number. If that’s the case, this should be resolved by talking with your provider to ensure they have the correct plan information. If that doesn’t solve the problem, please talk with health plan customer service representatives; the phone number is on the back of your card.
Is my health care covered if I travel through the U.S. and internationally?
Urgent and emergency services are covered when you travel across the U.S. and internationally. 
When traveling internationally, if you require urgent or emergency services, providers may not be able to bill your health plan; in those instances, you may need to pay at the point-of-care and request reimbursement from the health plan. Use the customer service phone number on the back of your ID card for more information.
Do U-M Medicare Advantage plans cover vaccines?
Yes, but it depends upon where you receive them. Under U-M’s Prescription Drug Plan, all CMS-recommended vaccines are covered through contracted pharmacies; some are covered at participating physicians’ offices. It’s important to use the appropriate contracted provider when receiving vaccines: 
  • Common vaccines for flu, COVID-19, pneumonia and hepatitis B are covered at participating physicians’ offices through U-M’s Medicare Advantage plans AND contracted pharmacies through the Prescription Drug Plan.
  • Vaccines for shingles; tetanus; Tdap; meningitis, hepatitis A; HPV; measles, mumps and rubella; polio; RSV; and tuberculosis are only covered when administered at a contracted pharmacy and billed under your prescription drug plan.
Do U-M Medicare Advantage plans include dental and vision care?
No. U-M dental and vision plans are separate from the health plans. The Dental Plan is provided by Delta Dental of Michigan, and the Vision Plan by Davis Vision by MetLife. Benefits-eligible U-M retirees can enroll in these plans during Open Enrollment.
A routine vision exam is a covered benefit under the Medicare Advantage plan for all members who elect to waive participation in the Vision Plan.
How do I get an ID card for a member of my family who hasn’t received one? 
Each Medicare Advantage member receives their own ID card. The cards are mailed separately in nondescript white envelopes. If a member has not received their card, inform your health plan by calling the customer service number on the back of your ID card. If your dependent needs health care services before receiving a card, the provider can confirm enrollment through the health plan provider portal.

Open Enrollment

How do I enroll in Medicare Part A and B?
If you or a covered dependent is eligible for Medicare when you retire, you are eligible to enroll during the Special Enrollment Period (SEP). Ninety days before the month you retire, call the Shared Services Center - HR Customer Care at (734) 615-2000 to request a retirement packet, which will contain a Request for Employment Information form. Take that form to your local Social Security Administration office the month before retirement to apply for Medicare Part A and Part B.
Once you receive confirmation of your Medicare Part A and Part B effective dates with your Medicare Beneficiary Identification Number (MBI), complete the eForm or contact the SSC - HR Customer Care for further guidance.
How do I enroll in a U-M Medicare Advantage plan? 
Once you are 65 and retired, you transition into the U-M Medicare Advantage plan associated with your current health plan. Being eligible for Medicare is not a qualifying life event to change plans.
If you’d like to change plans, you can do so during Open Enrollment each October by selecting a plan through Wolverine Access or by submitting the paper election form in the Retiree Open Enrollment book. 
If you are satisfied with your current health plan, no action is needed during Open Enrollment.
Should I pay for both the Medicare Part B premium and the university premium?
Yes. You will have two monthly premiums: one for Medicare and one for the university Medicare Advantage plan. You must remain enrolled in Medicare parts A and B to be eligible for U-M health coverage.
What actions can retirees take in preparation for Open Enrollment?
Ensure that your home address and phone number are up-to-date in Wolverine Access.
Be on the lookout for communications in August, September and October from the U-M Benefits Office. You will receive an enrollment booklet to your home and several emails to your U-M address. Check your mail and email regularly.
You can also help by being aware of, for yourself and when you communicate with your peers, the differences between the individual, publicly available, marketed products and the U-M group health plans:
  • View only U-M Benefits Office websites for information about your retiree health plans. 
  • View only U-M Benefits Office mailings. Our materials will direct you to call the Shared Services Center - HR Customer Care at (734) 615-2000.

Providers and Network

How do I get a provider list for health plans with preferred networks? 
A full list of participating providers is available using online directories on the Medicare Enrolled web page. If you have questions regarding specific providers, contact your health plan using the customer service number on the back of your ID card.
Do I need to change my providers?
It depends on whether the provider is a participating provider in your selected Medicare Advantage plan. Many Medicare providers also participate in the Medicare Advantage plans. To be certain, check the health plan’s provider directory or call the customer service number located on the back of your ID card. Your provider can also confirm if they participate with your health plan.
It is important to verify participation before your visit or service. If your provider does not participate with your Medicare Advantage plan, you might be responsible for out-of-pocket charges for treatment. Contact your health plan for more information.
Do all Michigan Medicine doctors participate in U-M Medicare Advantage plans?
Yes. If you receive a bill for services from a Michigan Medicine provider that is more than your anticipated copay, contact the health plan.
I’m concerned that Medicare Advantage plans offer only a narrow network of providers.
U-M Medicare Advantage plans have provider networks similar to the plans offered to our active faculty and staff. We have learned that limited access to providers has been a concern with publicly offered Medicare Advantage plans. (U-M’s MA plans are not the same as the publicly available MA plans.) 
U-M’s Medicare Advantage PPO plan has retained 95% of its Michigan-based providers and 92% of the national providers utilized by members during the two years prior to the conversion to the Medicare Advantage Plan.
Where have you seen limitations in the network of providers for U-M Medicare Advantage?
Individual providers, physician groups, and hospitals can choose to move in and out of networks periodically. While we cannot guarantee the participation of all providers nationally, we do continue to provide an extensive national network of exemplary providers.
I am enrolled in the Medicare Advantage PPO plan and my provider is no longer in the network. Can I continue to see my provider?   
To be certain, check the health plan’s provider directory or call the customer service number located on the back of your ID card. In some instances, the plan will cover services from out-of-network providers if the provider participates with Medicare, services are covered benefits and are medically necessary.   

Notify your provider that you have out-of-network benefits and ask your provider to bill the health plan. If needed, reference the "Non-Participating Provider billing" letter on the University of Michigan Medicare Advantage plans resource web page. 

Can I enroll in the university’s Prescription Drug Plan, but not enroll in a U-M MedicareAdvantage plan?
No. The U-M Benefits Office bundles the premiums for our health care and prescription drug plan.

Original Medicare/Supplemental Plans/
U-M Medicare Advantage Plans          

How do I know if a health plan is a U-M Medicare Advantage plan?
The best source is the U-M Retiree Open Enrollment book, or the LTD Participant Open Enrollment book mailed in late September/early October. Another trusted resource is the Michigan Medicare Advantage plan web page.
If you’re unsure about the source of information for the university’s Medicare Advantage plan, contact U-M’s Shared Services Center - HR Customer Care at (734) 615-2000 or email  [email protected].
If I wanted to have original Medicare with a supplement (Medigap), rather than a Medicare Advantage plan; can I do this through the university?
No. The health plans offered to U-M’s Medicare-eligible retirees and Medicare-eligible LTD Participants are the Medicare Advantage plans. If you choose to have original Medicare with a supplemental plan, you must purchase a publicly-available supplemental plan. You would also need to enroll in prescription drug coverage, or Medicare Part D.
I am considering moving out of the U.S. after retirement. Do U-M’s Medicare Advantage plans cover health care abroad if I permanently live in a different country? 
U-M does provide healthcare options for individuals residing internationally. There are factors to consider before making a decision. Please contact U-M’s Shared Services Center - HR Customer Care at (734) 615-2000, to discuss your personal situation with a representative.
If I’ve maintained my Medicare coverage while living internationally, and I move back to the U.S., what do I need to do to re-enroll?
It is best to contact U-M’s Shared Services Center - HR Customer Care at (734) 615-2000 to discuss your situation with a representative prior to your return to the U.S.
If I’m enrolled in a U-M Medicare Advantage plan, do I also need to purchase a Medicare Part D prescription drug plan?
No. There is no change in your prescription drug coverage. The university provides prescription drug coverage that is comparable to a Part D plan. There is no need to enroll in a separate Part D plan. If you enroll in a separate Part D plan, you will automatically be disenrolled from the university’s Medicare Advantage plan.
How do the U-M Medicare Advantage plans coordinate with other health plans such as through a spouse, previous employer or government?
  • Medicare Advantage – You cannot be enrolled in more than one Medicare Advantage plan at a time.
  • If you are also covered, or have the option to be covered through another plan as a spouse or by a previous employer, and the coverage is not a Medicare Advantage plan, contact that administrator to determine if their plan coordinates with your Medicare Advantage plan. 
  • Veterans Affairs (VA) – You can have VA and MA at the same time, but they must be used separately. VA benefits can be used at VA providers; however, the VA cannot bill your MA plan for out-of-pocket expenses. You can use your MA plan for covered benefits at in-network providers that do not include VA providers.
As a retiree/survivor, I previously disenrolled from the university’s Medicare Advantage health plans. Will I be allowed to re-enroll in the university’s health plan later?
Retirees, survivors and their covered dependents enrolled in Medicare may return if you have maintained continuous medical and prescription drug coverage that is comparable to the university’s coverage from the time of disenrollment to the time of return. The opportunity to re-enroll in our Medicare Advantage plan will be during the next Open Enrollment period, with a Jan. 1 effective date.
Before the Open Enrollment cutoff date, complete and return the Retiree Benefits Re-enrollment Form in your OE book or use the online form.
I am a retiree/survivor considering disenrolling from the university’s Medicare Advantage plans. What do I need to know?
You may voluntarily disenroll from the U-M Medicare Advantage plan. If you want to enroll in an individual Medigap plan:
  • If you do so during the first 12 months of being enrolled in the plan, you may benefit from "guaranteed issue" rights. These are temporary rights that protect you from pricing and coverage constraints due to your health condition, pre-existing health conditions, and history. The rights allow for individuals to return to original Medicare and then enroll in a publicly offered Medicare supplemental plan.
  • In short, you have a 12-month trial period from first enrollment in a Medicare Advantage plan, and up to 63 days after disenrolling from the Medicare Advantage plan, to switch to coverage with a Medicare supplemental policy. There may be differences in state and insurance carrier guidelines.
  • Given the variability of factors, if you are considering disenrolling from the university's Medicare Advantage plans, we encourage you to contact Medicare, the State Health Insurance Program, and/or the insurance carrier from which you intend to purchase a Medigap policy to confirm their requirements.
  • When discussing Medicare supplemental plans with insurance carriers, you are encouraged to emphasize that you are currently enrolled in a group Medicare Advantage plan.
If you want to enroll in another Medicare Advantage plan (e.g., publicly available or through another organization):
  • Before disenrolling, evaluate the potential out-of-pocket costs, including pharmacy coverage, to determine which plan works best for you.
  • You will need to disenroll from the university’s Medicare Advantage plan by submitting the Request to Waive Health Insurance Form.

For More Information

How can I be well informed about U-M benefits before and during Open Enrollment?
The following steps will help ensure that you’re informed and prepared for Open Enrollment: 
  • Check U-M’s dedicated Open Enrollment web page often for the latest information.
  • Make sure your home address and phone number are up-to-date in Wolverine Access.
  • Expect communications in August, September and October from the U-M Benefits Office. An enrollment booklet will be mailed to your home, and you will receive regular emails to your U-M account.