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.
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Over-the-Counter (OTC)
With our plan, members receive a $50 allowance each quarter to use for the purchase of select OTC products.
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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.
-
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
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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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| 2023 LIS Premium Summary Chart | View PDF
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| Medical Claim Reimbursement Form | View PDF
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