**Notice: This Medicare plan won’t be offered in 2024**
- The enrollment process should take about 15 minutes to complete. After your enrollment is processed, you will receive your plan materials along with a welcome call to answer any questions you might have.
- You will need your Medicare number to enroll. Before you get started you will want to make sure you have your Medicare card (the red, white and blue card) or your letter from the Social Security Administration handy.
- By completing this enrollment form you are sending an actual enrollment form to Advantage U. You will get an enrollment packet and a letter confirming your enrollment once your application has been approved by Medicare. Medicare beneficiaries may also enroll in the Advantage U Signature (PPO) plan through the Centers for Medicare and Medicaid Services (CMS) Medicare Plan finder at Medicare.gov/plan-compare.
- Once you submit your enrollment successfully, you will be provided with a confirmation number. Record this number for your reference until you receive your plan information in the mail.
Notice: This Medicare plan won’t be offered in 2024
This is a courtesy notice to let you know that beginning January 1, 2024, Advantage U Signature (PPO), Advantage U Signature Buyback (PPO) and Advantage U for University of Utah Retirees (PPO) will not be offered. This means you will need to obtain coverage from another Medicare plan for 2024.
Welcome to Advantage U
With so many Medicare coverage options out there, it can be hard to know which plan to choose.
Thankfully, there’s a plan you can trust that was born right in our backyard. A plan developed by Utahns with extensive health care experience and a dedication to providing Utahns like you with affordable coverage, benefits designed with you in mind and a network of doctors and hospitals you already know and trust. That plan is Advantage U.
Advantage U Signature (PPO) and Advantage U Signature Part B Buyback (PPO) is available for Medicare beneficiaries in Davis, Salt Lake, Tooele, Utah, and Weber Counties.
Advantage U Signature (PPO) includes
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Hospital and Medical Coverage
Advantage U offers the $0 Premium Advantage U Signature (PPO) plan.
- $0 Monthly Premium (you must continue to pay your Part B Premium)
- $0 Copay for In-network Primary Care Physician (PCP)
- $25 Copay for In-network Specialist Visit
For a complete listing of benefits please see Summary of Benefits.
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Prescription Drug Coverage
Our plan features a formulary (or drug list) with a broad number of prescription drugs on Tier 1 and Tier 2, so you can save more.
See Summary of Benefits for additional prescription drug coverage information.
Retail Cost-Sharing Tier 30-Day Supply 60-Day Supply 100-Day Supply Tier 1 (Preferred Generics) $3 copay $6 copay $0 copay Tier 2 (Generics) $10 copay $20 copay $20 copay Tier 3 (Preferred Brands) $47 copay $94 copay $141 copay Tier 4 (Non-Preferred Drugs) $100 copay $200 copay $300 copay Tier 5 (Specialty Medications) 31% coinsurance Not offered Not Offered Senior Savings Model: For Select Insulins, $28 copay for one-month supply is applicable in the Deductible, Initial Coverage and Coverage Gap phases of the Part D Benefit.
Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you even if you haven't paid your deductible. Call Member Services for more information.
Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible. A $28 copay for 30 days applies to Select Insulins for the Advantage U Signature PPO plan (see the formulary below for a list of insulins included in the program)
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Dental
Our plan includes preventive dental coverage with a $0 copay and comprehensive dental coverage for fillings, extractions, crowns, implants or adjunctive periodontal care. Up to $1,500 annual benefit for comprehensive coverage. Authorization rules apply.
See Summary of Benefits for additional dental benefits.
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Vision
We offer a $0 copay for routine vision exam along with coverage for eyeglasses or contact lenses ($120 limit on eyeglasses and contacts).
See Summary of Benefits for additional vision benefits.
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Hearing
Our plan includes a $0 copay for routine hearing exams through TruHearing along with hearing aid coverage.
See Summary of Benefits for additional hearing benefits.
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Fitness
Enjoy a Fitness Center Membership to participating fitness centers and choose to receive Home Fitness Kits.
You can visit a participating fitness center near you. You also have access to a variety of Home Fitness Kits. You can receive one Home Fitness Kits per benefit year.
The Silver&Fit® program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit®is a federally registered trademark of ASH and used with permission herein. Kits are subject to change. Participating facilities and fitness chains may vary by location and are subject to change.
-
Over-the-Counter (OTC)
With our plan, members receive a $50 allowance each quarter to use for the purchase of select OTC products.
-
-
-
Hospital and Medical Coverage
Advantage U offers the $0 Premium Advantage U Signature (PPO) plan.
- $0 Monthly Premium (you must continue to pay your Part B Premium)
- $0 Copay for In-network Primary Care Physician (PCP)
- $25 Copay for In-network Specialist Visit
For a complete listing of benefits please see Summary of Benefits.
-
Prescription Drug Coverage
Our plan features a formulary (or drug list) with a broad number of prescription drugs on Tier 1 and Tier 2, so you can save more.
See Summary of Benefits for additional prescription drug coverage information.
Retail Cost-Sharing Tier 30-Day Supply 60-Day Supply 100-Day Supply Tier 1 (Preferred Generics) $3 copay $6 copay $0 copay Tier 2 (Generics) $10 copay $20 copay $20 copay Tier 3 (Preferred Brands) $47 copay $94 copay $141 copay Tier 4 (Non-Preferred Brands) $100 copay $200 copay $300 copay Tier 5 (Specialty Medications) 29% coinsurance Not offered Not Offered Senior Savings Model: For Select Insulins, $28 copay for 30-day supply is applicable in the Deductible, Initial Coverage and Coverage Gap phases of the Part D Benefit.
-
Dental
Our plan includes preventive dental coverage with a $0 copay and comprehensive dental coverage for fillings, extractions, crowns, implants or adjunctive periodontal care. Up to $1,500 annual benefit for comprehensive coverage. Authorization rules apply.
See Summary of Benefits for additional dental benefits.
-
Vision
We offer a $0 copay for routine vision exam along with coverage for eyeglasses or contact lenses ($120 limit on eyeglasses and contacts).
See Summary of Benefits for additional vision benefits.
-
Hearing
Our plan includes a $0 copay for routine hearing exams through TruHearing along with hearing aid coverage.
See Summary of Benefits for additional hearing benefits.
-
Fitness
Enjoy a Fitness Center Membership to participating fitness centers and choose to receive Home Fitness Kits.
You can visit a participating fitness center near you. You also have access to a variety of Home Fitness Kits. You can receive up to 2 Home Fitness Kits per benefit year.
The Silver&Fit® program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver
is a federally registered trademark of ASH and used with permission herein. Kits are subject to change. Participating facilities and fitness chains may vary by location and are subject to change.
-
Over-the-Counter (OTC)
With our plan, members receive a $30 allowance each quarter to use for the purchase of select OTC products.
-
Advantage U Signature Part B Buyback (PPO) includes
-
Hospital and Medical Coverage
$0 Premium Advantage U Signature Part B Buyback (PPO)
- $0 Monthly Premium (you must continue to pay your Part B Premium)
- Up to $25 reduction for your monthly Medicare Part B Premium
- $0 Copay for In-network Primary Care Physician (PCP)
- $25 Copay for In-network Specialist Visit
For a complete listing of benefits please see Summary of Benefits.
-
Prescription Drug Coverage
Our plan features a formulary (or drug list) with a broad number of prescription drugs on Tier 1 and Tier 2, so you can save more.
See Summary of Benefits for additional prescription drug coverage information.
Retail Cost-Sharing Tier 30-Day Supply 60-Day Supply 100-Day Supply Tier 1 (Preferred Generics) $10 copay $20 copay $30 copay Tier 2 (Generics) $20 copay $40 copay $60 copay Tier 3 (Preferred Brands) $47 copay $94 copay $141 copay Tier 4 (Non-Preferred Drugs) $100 copay $200 copay $300 copay Tier 5 (Specialty Medications) 25% coinsurance Not offered Not Offered Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you even if you have not paid your deductible. Call Member Services for more information.
Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, even if you have not paid your deductible.
-
Dental
Our plan includes preventive dental coverage with a $0 copay and comprehensive dental coverage for fillings, extractions, crowns, implants or adjunctive periodontal care. Up to $1,500 annual benefit for comprehensive coverage. Authorization rules apply.
See Summary of Benefits for additional dental benefits.
-
Vision
We offer a $0 copay for routine vision exam along with coverage for eyeglasses or contact lenses ($120 limit on eyeglasses and contacts).
See Summary of Benefits for additional vision benefits.
-
Hearing
Our plan includes a $0 copay for routine hearing exams through TruHearing along with hearing aid coverage.
See Summary of Benefits for additional hearing benefits.
-
Fitness
Enjoy a Fitness Center Membership to participating fitness centers and choose to receive Home Fitness Kits.
You can visit a participating fitness center near you. You also have access to a variety of Home Fitness Kits. You can receive one Home Fitness Kits per benefit year.
The Silver&Fit® program is provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Silver &Fit®is a federally registered trademark of ASH and used with permission herein. Kits are subject to change. Participating facilities and fitness chains may vary by location and are subject to change.
-
Over-the-Counter (OTC)
With our plan, members receive a $30 allowance each quarter to use for the purchase of select OTC products.
Documents and Notices
Plan Benefits and Coverage Details
2023 Combined Summary of Benefits – Advantage U Signature (PPO) and Advantage U Signtaure Part B Buyback (PPO) – 3/22/2023 | View PDF
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2023 Advantage U Signature (PPO) Evidence of Coverage – 3/24/2023 | View PDF
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2023 Advantage U Signature Part B Buyback (PPO) Evidence of Coverage – 3/24/2023 | View PDF
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Annual Notice of Changes for 2023 – 3/24/2023 | View PDF
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2023 Provider Directory– 10/16/2023 | View PDF
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2023 Pharmacy Directory – 11/03/2023 | View PDF
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2023 Advantage U Signature Formulary – 11/03/2023 | View PDF
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2023 Advantage U Part B Buyback Formulary – 11/03/2023 | View PDF
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Supplies for Diabetes | View PDF
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Prescription Drug Transition Policy | View PDF
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2023 LIS Premium Summary Chart | View PDF
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Medical Prior Authorization Form | View PDF
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Enrollment Form | View PDF
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2023 Star Ratings – 10/15/2022 | View PDF
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Medical Claim Reimbursement Form | View PDF
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