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 below.
Medicare Enrolled Health Plan Information
View the plan profiles and coverage comparison information in the charts below.
| 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 Health Plan Information
View the plan profiles below.
View the 2024 Health Plan Coverage Comparison chart.
| 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. |
| PCP Selection Required | Yes. | Yes. | No. | No. | No. |
| 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. |